General Permits (5257)

CERTIFICATION OF EXEMPTI N
_Y FROM REQUIRING A CAMA PERMIT ,a ©EC 1 1:+96
as authorized by the State of North Carolina,
Department of Environment, Health, and Natural Resources a ission
in an area of environmental concern pursuant to 15 NCAC Su�l1N
Applicant Name 4Phone Number 91 b 79 I Lei!
Address 11631&1 N
City l I ) N - State ZiZ
Project location (County, 8tate Road, Water Body, etc.) SA n iPL_ Q!:::� fft�I�
Type and Dimensions of Project e- 1Z 7 2 1 „) X `I I,,— rWICL-1 1 0 x I
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.
ISKETCH
31�—
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.
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.
(SCALE: 1 (� 0 ' )
Co�TFic i Nti Cour�-i� IP�� � f _ L_A�� tci��
bilm
i
II J U W 1 V_
CAMA Offfcial's signature
I--- ;;� lI - 9-
Issuing date
(')-- C -9
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203
VA

i
• 5 , bi �
fl
•
1 � r � �
O O� 1 O
I