General Permits (3625)

-� 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
in an area of environmental concern pursuant to } PG�ebc# 203
Applicant Name \ Q ,N \. (� r� )� - I Phone Numberl � . 4 5'A4 -� 4 ��
Address Q U (
City C 4= State NC_ Zip �
Project Location (County, State Road, Water Body, etc.)�,..�,
Type and Dimensions of Project
10' x tt_' t .�,-- 0
The proposed project to be located and constructed as described
above is hereby certified as exempt from the CAMA permit re-
quirement pursuant to 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 ge -ds from the date of issuance. Following expiration,
a re-examination of the project and project site may be necessary
to continue this certification.
SKETCH (SCALE: N (DN ` )
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.
too
Applicant's signature
CAM90fficial's signature
Issuing date
Expiration date
7
Attacfararara �1nr3.Carolina Admicusirativod .0203