General Permits (187)

CERTIFICATION OF EXE
FROM REQUIRING A CAMA PERMIT ESE 1.7 12ik
as authorized by the State of North Carolina,
Department of Environment, Health, and Natural Resources and ion
in an area of environmental concern pursuant to 15 NCAC Su ch 9"hes"a""406WO
46 d
Applicant Name Phone
It Number 'IF
Address - I - rty
City
State - Zip 0
Project Location (County, State Roard, Wa e'r o y,etc.) 4
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Type and irffeftrtiI P't Jec-
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The propos6d project to be located and constructed as described This certification of exemption from requiring a CAMA permit is
above is hereby certified as exempt from the CAMA permit re- valid for 90 days from the date of issuance. Following expiration,
quirement pursuant to 15 NCAC 7K .0203. This exemption to a re-examination of the project and project site may be necessary
CAMA permit requirements does not alleviate the necessity of to continue this certification.
your obtaining any other State, Federal, or Local authorization.
-Ate-
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Any person who proceeds with a development without the con-
sent of a CAMA official under the mistaken assumption that the Applidant`ssignature
development is exempted, will be in violation of the CAMA if there
is a subsequent determination that a permit was required for the Y
development. CAMA Off iciKls signs fuir4-
The applicant certifies by signing this exemption that (1) the ap-
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plicant has read and will abide by the conditions of this exemp-
Issuing date
tion, and (2) awritten statement has been obtained from adja
cent._.. ..L
landowners objections to the -Ex—piraflon date
proposed Wo-tk----
Attachment: 15 North Carolina Administrative Code 7K.0203