General Permits (4987)

CERTIFICATION OF EXFV7ton
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FROM REQUIRING A CAMA PERMIT JAN
as authorized by the State of North Carolina,
Department of Environment, Health, and Natural Resou astal Resourc ommission
in an area of environmental concern pursuant-t4-1 o7K-:0.2A3:-
Applicant Name +�f• Ltccl%.: � � Phone Number f 37- 64
Address //50
City ) State A,1 zip
Project Location (County, State Road, Water Body, etc.)
!7�
Type and Dimensions of Project "s �,�•/ r� yk �4 r.Py �:>>
The proposed project to be located and. constructed as described
above is hereby certified as exempt from the CAMA permit re-
quirement puFsuant4o--f 5­NGAG, 7tC .&[e-mail] exemption to
CAMA permit requirements does not alleviate the necessity of
your obtaining any other State, Federal, or Local authorization.
This certification of exemption from requiring a CAMA permit is
valid for-9G-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 t .. ,r c,.,: r :I
I SKETCH (SCALE: �:,; )
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 front adjaeent.__
landowners —certifying-1haT---they:..have no:_ objections-. to —the
- proposed. work.
Appncanrs signature y +
CAMA Official's sign ure
J - /0 - I
Issuing date
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203