General Permits (237)

Applicant Name
Address
City
Project Location
CERTIFICATION OF EX
FROM REQUIRING A CAMA PERMIT
as authorized by the State of North Carolina,
Department of Environment, Health, and Natural Resources
in an area of�environmental concern pursuant to 15 NCAC S
,Tevr J4 h- 5- w e-S
State Mad, Water Body, etc.)
Type and Dimensions of Project ? c
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
M
1
BE 1 1
n otA ryirr fig sion
0203. ® t�
Phone Number
zip
c) ice, t� f
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.
SKETCH F_tl a ,,D iS A -E;C- (SCALE: / ` :A, It- )
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 obtained from adjacent
landowners certifying that they have no objections to the
proposed work.
—
Appficar isignature s
CAMA Official's signature
91- 1` b
Issuing date
d—
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203