General Permits (5418)

O
CERTIFICATION OF EX
FROM REQUIRING A CAMA PERMIT DEC
as authorized by the State of North Carolina,
Department of Environment, Health, and Natural Resources a I
in an area of environmental concern pursuant to 15 NCAC SubZR'2TTl�'.02Lf'�3"""4�'"'��•
Applicant Name
Address oo
City
Project LocationlCounty, State_Road, Water Body
and Pimensions of Project
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
1-7
S
/
N Y
t _ -A
Xx.
of
Phone Number S -Z4171Z
Statea e _ 1
.1 Zip 22FQ
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.
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.
(SCALE:
P16
A icant's sig tureZ
d
CAMA Official's signature
Issuing date
?
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203