General Permits (4060)

CERTIFICATION OF EXE _T
FROM REQUIRING A CAMA PERMIT AP 41997
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as authorized by the State of North Carolina, 3.28 -402.,
Department of Environment, Health, and Natural Resources and �Jt'6 fission
in an area of environmental concern pursuant to 15 NCAC SubchIRPM 7fC�h '5ft,
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Applicant Name 091p11' o e ' ' ' Phone Number 4
Address Anne
City 54rjr C-+ State Zip C�
Project Location Counter, State Road, ..W ter Body, etc.) er'" t r141
Type and Dimensions of Project C3 C-K.� 104 AC Dean
The proposed project to be located and constructed as described
above is hereby certified as exempt from the CAMA permit re-
quirement pursuant to 15 NCAC 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.
I SKETCH (SCALE: k1trr Ti, ) 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.
(V+
Apptican s signature
CAMA Of1icial's�siignaature O(�
N 17
Issuing date p
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203