General Permits (5854)

CERTIFICATION OF E EMPTIO�N r.
FROM REQUIRING A CAMA PERMIT I;
as authorized by the State of North Carolina,%
Department of Environment, Health, and Natural Resourcnmission
in an area of environmental concern pursuant to 15 NCAC Subchapter 7K .0203.
Applicant Name QJLSN 5 [ONLL. Phone Number .;&1_
Address 1"L L i% .ti J`I G_Y' .
City v I F-, r i .,t r-. U., i Rx., (4, State Zip -2 4f'Ll c r>
Project Location (County, State Road, Water Body, etc.) s"f (tc.rtLti4 3,2 , (UI✓. / 14;Ji
'O )P iu Ks C t LL—_ ,r < UT" r� f i n &I r' e?. G L )c .
Type and Dimensions of Project c'(Q 7 t
41
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.
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This certification of exemption from requiring a LAMA 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.
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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 signature Q
J" {
CAMA Official's signature
Issuing date
z/ i % "77
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203

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