General Permits (286)

CERTIFICATION OF EXEMP bN
FROM REQUIRING A CAMA PERMIT SEP 2%993 l
as authorized by the State of North Carolina, r- - �s '
Department of Environment, Health, and Natural Resources and the Coas I9-6d"sLJ
in an area of environmental concern pursuant to 15 NCAC Subchapter 7e..tf2'C' ! -------------
Applicant Name �� ` c. Phone Number
Address:' 7 rn t S
City �//o 2 /: !/
Project Location (County, State` Road Water Body, etc.)
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.
State c Zip _Ta��—�
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 � ram, � �' / ,7- (SCALE: . 't
n
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.
{: "' I ,
Issuing date
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203