General Permits (4172)

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CERTIFICATION OF EA VPTION�'1, �ro- I,
FROM REQUIRING A CAMA PERMI'
as authorized by the State of North Carolina,
Department of Environment, Health, and Natural ResourcE
in an area of environmental concern pursuant to 15 NCAC
Applicant Name �.,: hf1
Address f1 ol
City
Project Location (County, State Road, Water Bqd etc.) Y15 10 Lk)
D r l✓c) C�h AA wJ t C
Type and Dimensions of P
C
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.
D E C " 1996
mission
Phone Number
f ; ,
State Zi �641 H
u 9 I t" hn iCj 5hurr
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:
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.
Applicant's signature
I CAMA OffIpial's signature
Issuing date
Expiration date f
Attachment: 15 North Carolina Administrative Code 7K .0203