General Permits (5001)

CERTIFICATION -OF EXEM
FROM REQUIRING A CAMA PERMIT
as authorized by the State of North Carolina,
Department of Environment, Health, and Natural Resources and the
in an area of environmental concern pursuaatte�5 fJE�+.C-�absFaapf
Applicant Name
Address I.r 'o i
City
Project Location (County, State Road, Water Body, etc.)
State
FEB 1 4 1997'
'f��Kces.S� C
--------------
Phone Number U(16-7ib' /
7 /,
Type and Dimensions of Project / /mac' E h4 F y x R8a rz,,:,t /S k 2 T
The proposed project to be located and constructed as described
above is hereby certified as exempt from the CAMA-permit re;-
quirement .gUL,%jADt�5AGAC. 7-K--029 ,--This exemption to
CAMA permit requirements does not alleviate the necessity of
your obtaining any other State, Federal, or Local authorization.
Cc -
sTr 'i r•
This certification of'exemption from requiring a CAMA permit is
valid for-99rdays from the date of issuance. Following expiration,
a re-examination of the project and project site may be necessary
to continue this certification.
j SKETCH (SCALE: 462,� ) 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 statemep_t;h�s:beenAbtaieed from adjacent
landowners -certifying•--that-they have,. -no -objectio.ns_10_1.Ge
proposed -.work.
Applicant's signature
CAMA Off icial's signature
Issuing date
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203