General Permits (4688)

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CERTIFICATION OF EXEMPTION
as authorized by the State of North Carolina,
Department of Environment, Health, and Natural Resources and t�&Coasta4-Resoumest-G(5mmission
in an area of environmental concern pursuant to 15 NGAG-Subchapter 7K-.0203.
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Address
City
Project 'Location (Cou
ty, State Road, Water Body, etc.) z
Type and Dimensions of Project
The proposed project tvbelocated and constructed oadescribed
above is hereby certified an exempt from the CAMApermit re-
quirement pursuant to 15`NCAC_7N.8203. This exemption to
OAMA permit requirements 600a not alleviate the neoaoahy of
your obtaining any other State, Federal, orLocal authorization.
Any person who proceeds with adevelopment without the con-
sent odoCAyWAofficialunderthomiotakon000umptionthottho
development isexempted, will boinviolation nfthe CAMAif there
iaosubsequent determination that upermit was required for the
development.
The applicant certifies bysigning this exemption that (1)the ap-
plicant hasmadandwiUabidebyth000nditionoofthisoxomp'
don.and(2)owritteno1atomonthaaboonobtminodfmmadjaoont
landowners certifying that they have no objections to the
proposed work.
This certification ofexemption from requiring oCAMApermit is
valid for 9Udays from the date ofissuance. Following expiration,
are-examination ofthe project and project site may bonecessary
to continue this certification.
Applicant's siQAature
Issuing date
vC��
Expiration date
Attauhnzun1 15.NorthCanolina-AdmmrmratwoCode /n.ozuu