General Permits (4038)

CERTIFICATION OF EXEMPTIO
FROM REQUIRING A CAMA PERMIT ,`UN 1�9 1997f 3
as authorized by the State of North Carolina,lJ..:)LI
Department of Environment, Health, and Natural Resources and the Coa_______-
in an area of environmental concern pursuant to t5--NCAC Subachapter a K--.0203.
Applicant Name 1 C �d�',c ,'t�. f c:, Phone Number �1Vlti y ` J
Address � 11.
City
Project Location Cot
!1
Type and Dimensions of Project :r z« is ..G : - :_ ,�v. cx_ `QUQ :`•�.. t.�
The proposed project to be located and constructed as described
above is hereby certified as exempt from the CAMA permit re-
quirement pursuant to 1.5:-N�AC:.7K:.0203. This exemption to
CAMA permit requirements does not alleviate the necessity of
your obtaining any other State, Federal, or Local authorization.
This certification of exemption from requiring a CAMA permit is
valid for 90 days from the date of issuance. Following expiration,
a re-examination of the project and project site may be necessary
to continue this certification.
SKETCH .. _ (SCALE: `. )
i—
Any person who proceeds with a development without the con-
sent of a CAMA official under the mistaken assumption that the
development is exempted, will be in violation of the CAMA if there
is a subsequent determination that a permit was required for the
development.
The applicant certifies by signing this exemption that (1) the ap-
plicant has read and will abide by the conditions of this exemp-
tion, and (2) a written statement has been obtained from adjacent
landowners certifying that they have no objections to the
proposed work.
/ im
r (Y (felt- l L --tom i t i ,, �t -
gip" licant's signature
CAMA Official's signature
k'v),\_1 7
Issuing date
Expiration date
Attachment:°-15-Norti4-C= ina-' nirristrative-eede-7K-02'03