General Permits (5801)

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CERTIFICATION OF EXE
FROM REQUIRING A CAMA PERMIT
as authorized by the State of North Carolina,
Department of Environment, Health, and Natural Resources and the
in an area of environmental concern pursuant to 15 NCAC Subchap-
Applicant Name J_)At� d u %(C S
Address r—X,3 ov r-s,GdL rilieJ
City riA State
Project Location (County, State Road, Water Body, etc0..)�,,•
Type and Dimensions 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.
1 R .UeV15
Phone Number 3ra� Pa
Zip s
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: WOi O ) I
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(p (U 6 -/'CeftY`6Wo s or 1) Cvf\"i
17 ..,1100
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.
A ficant's_jsignature
CA
Issuing date
Expiration date
re
Attachment: 15 North Carolina Administrative Code 7K .0203

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