General Permits (5451)

-1r-
CERTIFICATION OF EXE
FROM REQUIRING A CAMA PERMIT
as authorized by the State of North Carolina,
Department of Environment, Health, and Natural Resources and
in
// an area of environmental concern pursuant to 15 NC,(AAC Subcl
Applicant Name t. Wr 1 �' i r' ��
Address / �,=� r c1
City 1::, ! S
Project Loc tion (County, State Road, Water Body, etc.) E"„ I ,-F 6,, d
and Dimensions of Project P
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.
-r
E
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.
I SKETCH (SCALE: jV,,e
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.
Applicant's sjga
t
lure
CAMA Off icia
sign
Issuing date J
Expiration date I /
Attachment: 15 North Carolina Administrative Code 7K .0203