General Permits (3221)

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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
i in an area of environmental concern pursuant to 4
Applicant Name 1 ` `OSe5 Phone Number q1S
Address
City State Zip-�—
Project Location (County, State Road, Water Body, etc.) \^ c.
Type and Dimensions of Project _ ,. • a '
The proposed project to be located and constructed as described
above is hereby certified as exempt from the CAMA permit re-
quirement pursuant to 45-N8AG-8i3 This exemption to
CAMA permit requirements does not alleviate the necessity of
your obtaining any other State, Federal, or Local authorization.
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.
This certification of exemption from requiring a CAMA permit is
valid for9@:days from the date of issuance. Following expiration,
a re-examination of the project and project site may be necessary
to continue this certification.
(SCALE:
Applicant's signature
C fficial's signature 6
ao
Issuing date
Expiration date
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