General Permits (2173)

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Applicant Name
Address -1
City
Project Location
-16itt—
CERTIFICATION OF EXEMPTION
FROM REQUIRING A CAMA PERMIT
as authorized by the State of North Carolina,
Department of Environment, Health, and Natural Resources and the Coastal Resources Commissio'
in an area of environmental concern pursuant to 1S�PfE� 290.
Phone Number r'G`��'
nty, State Road, Water Bo
dy, etc.)
The proposed project to be located and constructed as described
above is hereby certified as exempt from the CAMA permit re-
quirement pursuant to _T&-PCAG--7 --.e2 . This exemption to
CAMA permit requirenlAts does not alleviate the necessity of
your obtaining any otkter State, Federal, or Local authorization.
State
Zip
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.
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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, anclf-2 a&written-statement has been obtained4emadjaeent
.slandowp.ers-.certifying_ that.-they--have_..no--ebjections-to the'
proposed-work.
I ..
CANIA Official's signature
" `s s
Issuing date ' Ar
Expiration date
Attachment: 151Vort#�ain7�drartistfaiVe.-kg@'