General Permits (5549)

CERTIFICATION OF E rx
FROM REQUIRING A CAMA PERM DEC
as authorized by the State of North Carolina,
Department of Environment, Health, and Natural Resour
in an area of environmental concern pursuant to 15 NCAQ S
Applicant Name
Address
City State
Project Location (County, State Road, Water Body, etc.)
Type and Dimensions of Project
ti 1896
ommission
Phone Number :
Zip
The proposed project to be located and constructed as described This certification of exemption from requiring a CAMA permit is
above is hereby certified as exempt from the CAMA permit re- valid for 90 days from the date of issuance. Following expiration,
quirement pursuant to 15 NCAC 7K .0203. This exemption to a re-examination of the project and project site may be necessary
CAMA permit requirements does not alleviate the necessity of to continue this certification.
your obtaining any other State, Federal, or Local authorization.
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.
CAMA Official's signature
C
Issuing date i
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203