General Permits (254)

nCERTIFICATION OF EXEM
__Y_ FROM REQUIRING A LAMA PERMIT n,WDEC'l S 1995
as authorized by the State of North Carolina,
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Department of Environment, Health, and Natural Resources and the C a esources
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in an area of environmental concern pursuant to 15 NCAC SubchapterIIIl7�ir3
Applicant Name G r"tb f ,t t % 4 r, Phone Number
Address , e J V ✓
City ,, , State
Project Location (Cou ty, State Rogd, Water`ody, etc.) f n c,- 0 5 ' �r
R c J r , . n i r^ , !V ( ID � - / tR e l C Q CD ^ C� r . Ca n f u r
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.
io 1?yy- Sri 9.�
Zip �2,7,q-a
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.
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All 'itivi rc F �
i�r o .r r 1p u r% y n (a /` r
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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
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.
ure
CAMAjbfficial' signature
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Issuing date
Expiration date
Attachment: 15 North Carolina Ad ministrative'Code 71<.0203