General Permits (3227)

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OF EXEMPTION
FROM REQUIRING A CAMA PERMIT
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as:authonz'ed by the Stat
Department of Environment,` Health, and Natural Resources and the Coastal Resources Commission
- in an area of environmental concern
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Applicant Name
Phone Number
.Address
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City ^. r
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State
``Pro ect Location o nt ,State Road,
1 Y - Water Body; etc.)
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n' i i and D mens n o s of Pr
Yp ect
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The proposed project to be located and constructed as described
This certification of exemption from requirmg a'CAMA permit is •.
above is hereby certified as exempt from the CAMA permit re-
valid for 9e-d6ys,from the date of issuance. Following expiration,
quirement is exemption to .;
a re-examination of the project_and project site may be necessary .
CAMA permit requirements, does not alleviate the no of
to continue this certification.
. .
yourobtaining any other State; Federal, or Local authorization::
SKETCH G - -- (SC �n� )
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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- Iss , at
plicant has read and will abide by the conditions of this exemp-
tion, and (2) a written statement has been obtained from adjacent I_�g
landowners certifying that they have no objections to the Expiration date
proposed work.