General Permits (3619)

CERTIFICATION OF EXEMPTION v
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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 environmental concern pursuan17r6i5N`C7AC7Subchapter-7K- 0203•:
Applicant Name
Address
City t e, ,
Project/ Location (Co
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Water Body, etc.) -ate
State
PhoneNumber
GG
Zip
Type and Dimensions of Project � * !a /a X l�''s�;'cre o: e
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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 -to 1-5 NCAG 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 from 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 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.
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Applicant's signature
/CAMA/�fficial's-signature
iss mg
Expiration date
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