General Permits (3228)

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ERTIIF
�I OF EXEMPTION
FROM REQUIRING A CAMA
.: s .�; i _.-.r { .,t ..x*,.aw.-or:/-r+a•>R N4J - _ ,PERMIT
.as authorizedbythUSr
_
Department of Environment, Health, and Natural Resources and the Coastal Resources Commission "
in an area of environmental concern '
Applicant Name% Phone Number
Address _ -
Y State Zip
Project Loca ion (County;"State Road, Water Body,"etc. - -
Type and Dimensions of Project -
..'
C,
The proposed project to be located and constructed as described This certification o exem do r . f n f om re uirin a CAMA per
mit m�
q g P. is ...
above is -hereby certified as exempt from the PAMA permit re- valid for@.$riays from the date of issuance. Following expiration, `
quirement` .' This exemption to a re-examination of the project and project site may be necessary
CAMA permit requirements does not alleviate the necessity of to continue this certification.
your obtaining any'other State, Federal,
�orr Local authorization.
SKETCH 61 (SCALE:
IL Li I It I I I i {
dicta ,n nt�; . °.
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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, and (2) a written statement has been obtained from adjacent
landowners certifying that they have no objections to the
proposed work.
'31 ,, !„ %y q
Expiration d to