General Permits (6965)

-� CERTIFICATION OF EXEMPTION
FROM REQUIRING A CAMA PERMIT
as authorized by the State of North Carolina, �� t j ZGQZ
Department of Environment, Health, and Natural Resources and the Co al Resources Commission
in an area of environmental concern pursuant to 15 NCAC Subchapter 7K .0203.
Applicant Name f d' /-t W 6 r-, Phone Number
Address
City
Project Location (County, State Road, Water Body, etc.)
1114A Mw J
v +� 4- ,
Type and Dimensions of Project
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.
SKETCH
Q-
States Zip -�
,
ct`� 1slon f�'<' ra L
PAJ
This ccrtification 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.
(SCALE: )
a !a ( �4 r �.
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.
Applicantssignature
CAMA Official's signature
Issuing date r
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203