General Permits (303)

7 fl?1 o R
CERTIFICATION OF I" TUR)
FROM REQUIRING A CAMA PERI PR 19 1993
as authorized by the State of North Carolina,
Department of Environment, Health, and Natural Reso a �i"'Ctssit... Commission
in an area of environmental concern pursuant to 15 NC C Subchapter 7X;j9-___�
Applicant Name '\' r Phone Number
Address
City State L- Zip _
Project Location (C1ounty�,, Sta/t Road, Water Body, etc.)-
1=
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-71K.0203: This exemption to
CAMA permit requirements does not alleviate the necessity of
your obtaining any other State, Federal, or Local authorization.
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� . 1l i 51 4 cG (SCALE: 41,,; )
I
K�EM)b,
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.
Will
,P1
aN
Applicant's signature
CAMA Official's signature
Issuing date
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203