General Permits (3610)

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CERTIFICATION OF EXEMPTI� MIR,�
Y` FROM REQUIRING A CAMA PERMIT DEC 0 �1996 I
as authorized by the State of North Carolina, j
Department of Environment, Health, and Natural Resources and the Coastal Re o ~ribTi'"
in an area of environmental concern pursuantV t53 N0A",ubch-ap•saM�
Applicant Name
Address ,2K))+
City
Project Location
Tvge and Dimensions of P
.Ir
The proved project to b ooated and constructed as described
above is hereby certified as exempt from the CAMA permit re-
quirement•pursuant-to-1.5-NCA'C 7f4 .-0203. This exemption to
CAMA permit requirements does not alleviate the necessity of
your obtaining any other State, Federal, or Local authorization.
SKETCH
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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.
Phone Number SK /Y_Qt'
This certification of exemption from requiring a CAMA permit is
valid for9"rays 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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Applicant's signature
PAMA icial's-signature
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Expiration date
ttachmerlt: t'1�f�ritrCarolin"�1'rtminis ra eve Code 7K .0203 -