General Permits (5903)

CERTIFICATION 0 E" N
1� FROM REQUIRING A CAMA WP 2 7
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as authorized by the State of North Carolina,
Department of Environment, Health, and Natur x'ai ources Commission
in an area of environmental concern pursuant to>9�MI4A>fnlie.
Applicant Name 4 `• —4C P t f
Address } P>
City I A.'R!lfAT�,UILl6�1 '•_el1�
Project Location (County, State Road, Water Body, etc.)
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Type ano Dimensions of P
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 .020,5. This exemption to
CAMA permit requirements does not alleviate the necessity of
your obtaining any other State, Federal, or Local authorization.
M f - 6 44 �3a
Phone Numbt r P IC
State {l,_) Q, Zip
C
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.
SKETCH (SCALE: `.,,•; )
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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
CAMA Official' signature —
Issuing date,
. \ -2-
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .020.3