General Permits (5318)

CERTIFICATION OF EXEMPTIO. .W:
FROM REQUIRING A CAMA PERMIT JUN 1 2 1997 (i'
as authorized by the State of North Carolina, f
Department of Environment, Health, and Natural Resources and the Coast !J
in an area of environmental concern pursuant to 15 NCAC Subchapter 7K .
Applicant Name i.f Ilk 11 1vk,
Address Z_t` �; r k.' "f
City . t.
Project Location
' ation (County, States Road, Water Body, etc.)
f- i T'�4'iq 1 tif" v R!� ra t.,w-,c ( U.af f
Type and Dimensions of Project NX'V�''
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.
SKETCH � 11 d '"
r1
VY W V
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.
Phone Number f ! _'`_ 1q
State A.- ;( zip U
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:
)plicant's signature
CAMA Off icTI's si ature
Issuing date
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203