General Permits (280)

CERTIFICATION OF
FROM REQUIRING A CAMA PERMIT ,PR'k,
F S
as authorized by the State of North Carolina, A)Commission
Department of Environment, Health, and Natural Reso �"&�
in an area of environmental
`conce
rn pursuant to 15 NCGillppb�pter 7K .0203______
Applicant Name T0,A-,` ,A' ` 1 AV _ T I 'A Phone Number 2V O
Address id 0 T o
City �Ar? / ("
Project Location (County, State Road, Water Body, etc.)
Type and Dimensions of Project -�- / S ` r f (- f-11
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 Zip 7,2df
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 (SCALE: )
b U
tit/
P
IN I �t V_
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.
Applicant's signature
CAMA Official's signature
Issuing date
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203