General Permits (7147)

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CERTIFICATION OF- EXEMPTION-.
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FROM REQUIRING A CAMA PERMIT JUW 2 G ►� 4
as authorized by the State of North Carolina,
Department of Environment, Health, and Natural Resouf:iaad9 ivaa Commission
in an area of environmental concern pursuant to 15 NCA6bcuzpter_�K.s.
Applicant Name Lam. C . '� O-Y\ V
Address o7:), 1ki,<Ie
City I P to r State
Project Location (County, State Road, Water Body, etc.) SknnP--
Type and Dimensions of Project + -
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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.
Phone NumbergQ-3712—Ob
Zip1
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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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E A]lKNQ N 1 A LkAT� i
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 sil
CAMA Official's signature
411 -j-
Issuing da / _
Expiration date �/ E
Attachment: 15 North Carolina Administrative Code 7K .0203