General Permits (6948)

CERTIFICATION OF EXEMPTION
FROM REQUIRING A CAMA PERM�'T��
as authorized by the State of North Carolina,
Department of Environment, Health, and Natural Resources agtf3eq stso'urc
in an area of environmental concern pursuant to 15 NC�AC Sufpp r K . ,
Applicant Name k
Address �, i ' t •' ,' (L
City �.
Project Location (County, State Road, W
Type and Dimensions of Project
rm'ission
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Body, etc.) <_ i-- .
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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.
r
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: ) I
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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.
E 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.
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Applicant's signture
CAMA Official's signature
Issuing date
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Eicpiration date
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Attachment: 15 North Carolina Administrative Code 7K .0203