General Permits (401)

-.- chid T I i nos
Sf NW
CERTIFICATION OF iE ION �oQ
_Y FROM REQUIRING A CAMA PER I �, , .,19,3 DC 2°'°S
as authorized by the State of North Carolina,
Department of Environment, Health, and Natural Resources an Fie-'-'oastaH;esouxc"Commission
1 1 hartLl area of,gnviron, ntal concern pursuant to 15 NCA6. Subchapter 7K A203.
Applicant Name 3 t.S� �du {v e Phone Number — 3 f
Address f Pr ! z
City State Zip
Project Location (County, State Road, Water Body, etc.) '�)v ,1yUDuQ
Type and Dimensions of Project L; '
The proposed project to be located and constructed as described This certification of exemption from requiring a CAMA permit is
above is hereby certified as exempt from the CAMA permit re- valid for 90 days from the date of issuance. Following expiration,
quirement pursuant to 15 NCAC 7K .0203. This exemption to a re-examination of the project and project site may be necessary
CAMA permit requirements does not alleviate the necessity of to continue this certification.
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