General Permits (4627)

CERTIFICATION OF EXPAPTION'
_Y FROM REQUIRING A CAMA PERMIT D�
as authorized by the State of North Carolina, r�.O
cc��
Department of Environment, Health, and Natural Resources and t e4ra�s�o mi sion
in an area of environmental concern pursuant to 15 NCAC Subch pt
Applicant Name#Jk `��ho�Iy�Fi�fAHfAOrNi��xfr�.�, —
Address /.%arcs%` c
City fir! State �41e, Zip -2­71
Project Location (County, State Road, Water Body, etc.)
Type and Dimensions of P
1-091,8
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.
SKETCH
t) < /tt.r4/V&16*t.
6 13- 1i i` 01,,17
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.
(wi-,ZX ' (SCALE: _�
)IeAx
Ale"
� r C )fit t A i_ tit 'jam 5 VIC* t U Wig � 1S-t�, ��► � (-"4
�i�iS4vry 'T
�se�I�r
{ v*V re&_, 5 6AX I/. l/ E H. Sri%rti!F As Ne/_t-') CA.,
)tMArifte-i) ! hf , /RE)c, t
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-m
%A *-A
c�vi-fZ
7
Applicant's signature Chi
CAMA Official's signature
Issuing date
Expiration date `
Attachment: 15 North Carolina Administrative Code 7K .0203