General Permits (471)

CERTIFICATION OF K19111
_Y FROM REQUIRING A CAMA PERMIT APR 2 7 199
as authorized by the State of North Carolina,
.i
Department of Environment, Health, and Natural Resou s '� da f 1& ommission
in an area of environmental concern pursuant to 15 NCAC Subchapter 7K .0203______�
Applicant Name +' 'v !;; Phone Number
AddressLA
City �'i _ State A., C_ Zip %cs
Project Location (County, State Road, Water Body, etc.) _ O-
Type and Dimensions of Project �1- �� ! _ _� 1
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.
SKETCH
J
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.
l � -�-L �✓" f �,/�
��vl rt ► %T 11)4l
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.
(SCALE:
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Applicant's signature ?�
CAMA Official's signature
Issuing date `
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203