General Permits (8171)

CERTIFICATION OF EXEM
FROM REQUIRING A CAMA PERMIT
as authorized by the State of North Carolina,
Department of Natural Resources and Community Development and
in an area of environmental concern pursuant to 15 NCAC Subchaph
Applicant Name I �_
Address
City State
Project Location (County, JState Road, Water Body, etc.) J^, r"t ' : `f
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.
SKETCH
1'?!�
7 1991 lit
Phone Number ' (�
_ Zj
i ��1,1
This certification of exemption from requiring a CAMA permit is
valid for 60 days from the date of issuance. Following expiration,
a re-examination of the project and projed site may be necessary
to continue this certificatioq.
(SCALE:
Any person who proceeds with a development without the con- %' �_//
sent of a CAMA official under the mistaken assumption that the App icant s sgnatute
development is exempted, will be in violation of the CAMA if there t I I
is a subsequent determination that a permit was required for the
development. CAMA Official' sgnat e
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.
v
IL
Attachment: 15 North Carolina Administrative Code 7K .0203