General Permits (5818)

CERTIFICATION OF EXEMP
_Y R ;i, APR 2 1 1997
FROM REQUIRING A CAMA PERMIT ►<
as authorized by the State of North Carolina,
Department of Environment, Health, and Natural Resources and the CoasteWaftey�`o, fYQi
�
in an area of environmental concern pursuant to 15 NCAC Subchapter 7K .0203. ---
Applicant Name `� �� C f" ' Phone Number
Address e P -
City_-�s State Al C . Zip
Project 4ocation (Co u ty, State Road, Water Body, etc.) r.- :
Ty a fnd Dimensions of Project (.: 4 t J , U
C VAC oypre (A 6-)u +- 4- f�
t- ✓ f I U f 1 L- r- r-
r1 p p 11 piPr
The proposbd 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.
' t b .J ' \ A r« rd :, o r- S "(".r I ( ! f -
r- ) t 1 o O 10
IF
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: nL r e ) I
O r L
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.
iy
e.&Dlicann-sian ture
CAMA CMitial's t nature
v-L 7 -- u q
Issuing date
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203