General Permits (7262)

CERTIFICATION OF EXEMP
FROM REQUIRING A CAMA PERMIT I.
as authorized by the State of North Carolina,
Department of Environment, Health, and Natural Resources and the G
in an area of environmental conce in pursuant to 15 NCAC Subchapter
Applicant Name - --'°C. :. ,
Address
City State
Project Location (County, State Road, Water Body, etc.) -Da
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.
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.
J U N 2 8 1994
Phone Number.:)
Zip
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.
CAMA Official's signature
Issuing date
III -)/qq
Expiration date I j
Attachment: 15 North Carolina Administrative Code 7K .0203

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JACK Q. %TOCXS
H-C. Ittlistr"on No. L45A
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