General Permits (7197)

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Applicant Name C4i �d
Address
City 6-, State
Project Location (County, State Road, Water Body, et .) z 144 6 'i cA-i-�
CERTIFICATION OF EX '�'PTION
FROM REQUIRING A CAMA PERMIT L= o 9 `
as authorized by the State of North Carolina, CP,
Department of Environment, Health, and Natural Resources and the La�
in an area of environmental concern pursuant to 15 NCAC Sub( h?,p!er TKI Q3---------- "'
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Phone Number �Z, o, /
Type and Dimensions of Project 14L 1 ' . r I
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.
3-fG'5;�
Zip Z:72fflo;>
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.
sent of a CAMA official under the mistaken assumption that the Applicant's signature., I
development is exempted, will be in violation of the CAMA if there ��/ 1 /
is a subsequent determination that a permit was required for the ' `%r ' b�/�1`?.--
development. CAMA Official's signature
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.
v6/ 421 2�
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203