General Permits (6418)

6ERTIFICATION OF EXEMPTION
FROM REQUIRING A CAMA PERMIT
as authorized by the State of North Carolina,
Department of Environment, Health, and Natural Resources and the Cc L,R o�rces Commission
in an area of environmental concern pursuant to 15 NCAC Subchapter 7 ..020 1998
Applicant Name_ A'T
Address S .
City 6b - , • /
Project Location (County, State Road, Water Body, etc.)
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.
y,4. ee7 f
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.
Phone Number/%K )-7 - 63I itrU
State ti�z Zip 1/-2 4"
This certification of exemption from requiring a CAMA permit is
validfor 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
Applicant's sl
CAMA Official's signature
Issuing date
-.296
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203