General Permits (6046)

v
CERTIFICATION OF EXEMPT
FROM REQUIRING A CAMA PERMIT
as authorized by the State of North Carolina,
Department of Environment, Health, and Natural Resources and the Coast;
in an area of environmental concern pursuant to 15 NCAC Subchapter 7K .
Applicant Name 17/IA I -IL V L_ /q Phone Number
Address % 6%i % ;�/' , A) 5 /:7-&—XPz;i
City -A,
Project Location (County, State Road, Water Body,
Type and Dimensions of Project ,D ` 4,1 l 0
7�1 L L L
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.
_ State=x'= f
OCT 2 5 1999
61.'V 4- Zip
DJ#_4
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 i+J , (;. (SCALE: )
J&
AAA-)1- P
T
r
ju
I
rC V
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's signatu
Issuing date
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203