General Permits (4633)

A cant Name _7'�� Phone Number @s),
ppli
Project Locatio� (County, ' State Road, Water Body, etc.) z��—Lc'v�-tA C�
Type and Dimensions of Project
The proposed project tobolocated and constructed aodescribed
above is hereby certified as exempt from the CAMApemh re-
quirement pursuant to 15 NCAC ZK0203. This exemption to
CAMA permit requirements does not alleviate the necessity of
your obtaining any other State, Federal, orLocal authorization.
This certification ofexemption from requiring oCAMApermit is
valid for 9U-daymfrom the date ofissuance. Following expiration,
are-examination nfthe project and project site may bonecessary
to continue this certification.
SKETCH (SCALE:
Any person who proceeds with udevelopment without the con-
sent of a CAMA official under the mistaken assumption that the
development isexempted, will boinviolation ofthe CAMA if there
iaasubsequent determination that apermit was required for the
development.
The applicant certifies bysigning this exemption that (1)the ap-
plicant has read and will abide bythe 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'ssig nature
Issuing date
Expiration date
Attachment: 15North Carolina Administrative Code 7K�O2O3