General Permits (7121)

CERTIFICATION OF EXrS-E-
y ��_t.
FROM REQUIRING A CAMA PERMIT 199�4as authorized by the State of North Carolina,
Department of Environment, Health, and Natural Resources'� ission
in an area of environmental concern pursuant to 15 NCAC Subokaptex7.K.-a2Q3____.._-,,.�„
Applicant Name��_ti�� G.rck
Address ,%U ill r
City '"h
Project Locaation (County, State Road, Water Body, etc.)
e
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.
Phone Number�yq .-lc\ j G'A
-\\ State NC Zip
4 X x 1
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: IVC )
h� L.
_ t
I ! j
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.
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y x� I- -- -
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Ap IRicant's signature
CAMA icial's signature
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Issuing date
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203