General Permits (3826)

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CERTIFICATrbm 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-pwstteAt to-tf f p?.
Applicant Name 1w/f , „ Q r� 4 Phone Number $�i.
Address
City - 'dd"en State Zip
Project Location (County, tate Road Water 13od , etc.) ,,
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Type and Dimensions of Prpjec�tt TQL
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The proposed project to be located and constructed as described This certification of exemption from requiring a CAMA permit is
above is hereby certified as exempt from the CAMA permit re- valid for 99-day4s from the date of issuance. Following expiration,
quirement 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, or Local authorization.
SKETCH -(SCALE:
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AVO
Any person who proceeds with a development without the con- <� ^
sent of a CAMA official under the mistaken assumption that the Applicarr s ignature
development is exempted, will be in violation 'of the CAMA if there 1-1
is a subsequent determination that a permit was required for the �1///.�-s. 19
development. CAMAfficia�s'signature
The applicant certifies by signing this exemption that (1) the ap- 1A _ - 9l_
plicant has read and will abide by the conditions of this exemp- Issuing dafe
tion, and (2) a written statement has been obtained from adjacent -a
landowners certifying that they have no objections to the Expiration da�tel 99 9
proposed work.
Att aehrrrent--}5•i�iorttrC-a rofir�a-�4dm irnstrative-�de-�}(-62gg