General Permits (7279)

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CERTIFICATION Or EXEMPTIO ,,�)
FROM REQUIRING A CAMA PERMIT �° � °
as authorized by the State of North Carolina, "i ! i �QY 16,94
Department of Environment, Health, and Natural Resources' tat Re'stfurCes-Co'' mission
In an area of environmental concern pursuant to 15 NCAC Subcffaptb"r7K .0203:.......
Applicant Name S5 C et-1
Address 2
City
Project Loc?tion (County, State Road, Water tdft etc.)
The proposed project to be located and constructed as described
above is hereby certified as exempt from Rhe 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 � S 9+y9
State zq 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.
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Any person who proceeds with a development without the con-
sent of a CAMA official under the mistaken assumption that thb
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 signilAg 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.
:Apph,cant's snature
C c al s signature
Issuing dat��%�
Expiration dat
Attachment: 15 North Carolina Administrative Code 7K .0203

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