General Permits (5590)

CERTIFICATION OF EX
FROM REQUIRING A CAMA PERMIT
as authorized by the State of North Carolina,
Department of Environment, Health, and Natural Resources
in anf�area of environmental concern pursuant to 15 NCAC Suoer �.r�.4.b�w�s.w.was
Applicant Name hip If) � 1�t t � �-, ~ Phone Number °fit 9 �C^ 1 `l6 9 6`1
Address
City V < r. u i n C State PC1 Zip. s-98.51
Project Location (County, State Road, Water Body, etc.) /-VT cP P« k bf �1rc :S
i t.r,� k`u uP� G't�' CAMA61- % F' U{ 1tJ!J
Type and Dimensions of Project fa; �c.x k1201 ,� -a to �� r�n�( ( Ac•�f r-�'/ �' t
* (-- t /h C. U T " - 1 1 h, (-, '1 'y' i I '
�T
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�, tification 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 (SCALE:
14 vi,6f. P; {
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.
Applicants signature
t�
Y") f�
CAMA OTcial's signature /
Issuing date
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203

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