General Permits (3191)

Applicant Name
Address 74
City
Project Locatior
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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 Commission
in an area of enviro/n /mental concern pursuan"crl"CA1"vbctrapter'�:G203, cy6 y _,A �S.4 'kye
' , l�l! +areas Phone Number
Type and Dimensions of Project KEce+A /t�i/eye �lt1 no A_
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The proposed project to be located and constructed as described
above is hereby certified as exempt from the CAMA permit re-
quirement pursuant.4o 15-,NGAG 7K--.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 f om 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 wno proceeas witn a aevelopment wanout 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' i nature
CA A Off' s signature
h
Issuing date
Expiration date
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Attaehmwtt-l'5`Idotth-emiina-Admim o e :0203 "