General Permits (451)

Applicant Name
Address
City
Project Location
CERTIFICATION OF
FROM REQUIRING A CAMA PE
as authorized by the State of North Carolina,
Department of Environment, Health, and Natural RE
in an area of environmental concern pursuant to 15 NCAC__S%u hapfer_7K_02Q-3 ------
ty, State Road, Water
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.
rq,3
ssion
r
- � • L�l� 1�� w
i
.. -_ .i _
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: }
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
I-D I^
CAMA Official's signature r
Z/t��cjv
Issuing dat /l ,)
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203