General Permits (8045)

11
✓O
Applicant Name j
Address
City K' f
Project Location
CERTIFICATION OF EXE
YI FEB 1
FROM REQUIRING A CAMA PERMIT 9 1
`
as authorized by the State of North Carolina,
Department of Environment, Health, and Natural Resources and the o rces mmission
in an area of environmental cone rn Rursuant to 15 • CA S M t�V'I k_.. 03'.---------------
C71n W ► L!. ao� ►�S 1rt jJC1 !Q�
r �OA.AD 601vt n W1 I Ssl" Phone Number 32 7N-*'
_ VSKCb I- VT ► 1 box 4'�'
State Road, Water Bbdy, etc.)
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.
State N C_ Zip
-- 16 -7 -7 f -0 St - tip
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
Any person who proceeds with a development without the con- 1i
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.
s slan
CAMA Official's signature -�
Issuin e
Ex
Attachment: 15 North Carolina Administrative Code 7K .0203

I M
!!in
!Oil11 HOI,
Iffil;
'n
On I
11!
11
it
t
( q HHH1
0111"
11URI Ill
till!
DOWN,
"Oul
ii
iiiiiiij
H PI
HM144
I
fl!n�
ninui
Ili-nuill
no
H IN
Ulliail ll Hi
UU11111111
m�nin 4
Hull
fluffifill
Him
.4:1111M.
Lill
OWN]
will
HIOU
llOHNIll
Iiii:11111iii
JIM:
UmJi" Ilin
C'�
11,I11
'
Oil JOB
!]:Oil
OilN" 1111
HIUIII Jill
J
UI;::jII
� LK.
Oil
11 it
"iUM,
U
�1!11.11
if
11m)
Vill
H 10. IUD
I
IUD
IIIIIINI
-- "
HUHU.,
Hill -pi
In
lnilp
mulgi u
1111 H
01 In
I RU
1111 11OHIO
ill Oil
11 11
HU1
�inn
MIN
Until
111
OHIO 1111.111
ill OR
111RUP [I HIM
Ill,
111!. HIM 11
On
it it
Illfilfifl
�Wfliqlm
FIRION"
IT