General Permits (4561)

CERTIFICATION OF EXEM
FROM REQUIRING A CAMA PERMIT APR 19/ f
as authorized by the State of North Carolina, Of
Department of Environment, Health, and Natural Resources and the
in an area of environmental concern pursuant to 15 NCAC Subchapta4�ri6lws•+�sw
Applicant Name -E? t Vtt ` v ��� ti Phone Num6��� 2 6—' 7,6 (% y
Address L ` ) vlz,
City �- - S l _Z State Zip ((
Project Location ( ounty, State Road, Water Body, etc.), ! _ fiJ.0 Vr ,�+ r • t+) Ij; a V ( 1
Type and Dimensions of Project I,
_ �iA t 1
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.
r K AD--*,- :.J--`! C4-_( U
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: t%J / -(--f;- ) 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.
�t(?h
Applicants signat re I
CAMA Officiars s'-7gnature
Issuing date
7/397
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203