General Permits (7795)

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CERTIFICATION O ;.EXEMPTION
FROM REQUIRING A CAMA PER !T
as authorized by the State of North Carolina
Department of Environment, Health, and Natural R6so6rggCommission
in an area of environmental concern pursuant to 15rNGACSubch[?K .A�63 - '
Applicant Name Dr �A' A i I Phone Number
Address / 3 S L) V a CK /t f)04 V
City �:) t f C' {t_ State Al C~ zip 11
Project Location (County, State Road, Water Body, etc.) PAS 4%)r07't4n
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 +5--N46A5,7F�-'203-. This exemption to
CAMA permit requirements does not alleviate the necessity of
your obtaining any other State, Federal, or Local authorization...
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 ..... 1-! , Gi% (SCALE: A., y ) I
rf t
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 obtai-ned-frotn-adjacent
landowners- certifying --that - they -have .-no- -objections to --the
proposed -work. --
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Applicant's signature
CAMA Official's signature
Issuing date
piration date
Attachment:-15-North Garelina Administrative-Code7K-.02a3-