General Permits (3630)

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� CERTIFICATION ��-��_vJ�� � ��~��`� � ��~ EXEMPTION
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� FROM REQUIRING A CAMA PERMIT � -
as authorized by the State ofNorth Carolina, '
� Department of Environment, Health, and Natural Resources and the Coastal Resources Commission
inanarea ofenvironmental concern pursuant to
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� Address
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Project Location _`-__-, State .~.. Water.~~y~"^
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Type and Dimensions of Project
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The proposed project bobelocated and constructed aadescribed This certification ofexemption from requiring aCAMApermit is
above ishereby certified ooexempt from the CAMApermit re- valid for } o-Ircm1hedatoofinouonoo.Fu|lowingexpirouinn.
� | qui,amentpursuant to Thisexemption to are-examination ofthe project and project site may benecessary
� CAK8A permit requirements does not alleviate the necessity of to continue this certification.
your obtaining any other State, Federal, orLocal authorization.
SKETCH (SCALE:
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Any person who proceeds with a development without the c--n-
sent of a CAMA official under the mistaken assumption that the 'Applicant's signature
development is exempted, will be in violation of the CAMA if there
is a subsequent determination that a permit was required for the Z-1
development. CAMA Off icial's signature
The applicant certifies bysigning this exemption that (1)the ap'
p|�am has mad and will abide by the condh�noofthis exemp-
tion, Issuing ~~`~ '
ond(2)owrittanstatomenthaobeenob1ainedfmmadjaoent '
landowners certifying that they have no objections to the Expiration date
proposed work.
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