General Permits (4214)

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CERTIFICATION OF E IIPTIUN
_Y FROM REQUIRING A LAMA PERMI APR 1 0 1991
as authorized by the State of North Carolina,
Department of Environment, Health, and Natural Resource �e aommission
in an area of environmental concern pursuant to 15 NCAC TVMcn
Applicant Name c� ci ,.: �t �, A C- f^ i, ` Phone Number � .
Address > 2
City S ate f� ._ Zip J�a 6
Project Location (Co nty�State Roa , Water Body, etc.) r� r l � -(A V1
�
Cie c X
TypeandDimensions of Project
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.
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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: otp1'e- ) 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.
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Applicant"t'srsignature r✓ r), s
CAMA Official's signature
7 1°,_��
Issuing date
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203