General Permits (5422)

CERTIFICATION OF E)
FROM REQUIRING A CAMA PERMI-
as authorized by the State of North Carolina,
Department of Environment, Health, and Natural ResourcE
in an area of environment I concern pursuant td 15 NCAC
Applicant Name
Address r
City
Project Loca ion (County, State Road, Water Body, etc.)
r
� � ,.I• - .N -., 1.
JAN 2 9 1997 x '
u
p��mission
pter 7 0203.
Phone Number C�)5L_
State
Type and Dimensions of f Project - < — u to
t l 1 l", r
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.
This c(-rtification 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.
SKETCH fy '_ C�1 ; f 7aci (SCALE: )
cC C- C �_ t��.... . `� v �3
d
LoAZ1�
0
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.
Tfic-r
I
`�-,,,L.tc tAerft
Attachment: 15 North Carolina Administrative Code 7K .0203