General Permits (3827)

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CERTIFICATION OF EXEMPTI
ON
-, 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
- man area of environmental concern pursuant to
Applicant Name Phone Number r,4
Address uc, O'J
City G� State V o; Zip �b5
Project Location (County; State Road, Water Body, etc.)
-k\i
Type 9d D mks insof Project S r Y.,, L)arnG�c ru.\� cn 3 X 'tad' -cy C CJ
ch
The proposed protect to b- located and constructed as described This certification of exemption from requiring a CAMA permit is __':
above is hereby cert_rfied as exempt from the CAMA permit re- valid for"D8=d-a7s from the date of issuance. Following expiration,
quiremenf pursuant to is exemption to a re-examination of the project and project site maybe necessary CAMA permit requirements -does not alleviate the necessity of to•continue this certification -
our obtainin an other
-. Y _ . , 9 ,• Y r 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 Applicant's si9 nature '
development is exempted, will be in violation of the CAMA •rf there i �� J ��
is a subsequent determination that a permit was required for the � �. 1 lC' � _
development. CAMA Official's signature
The applicant certifies by signing this exemption that O ap-
plicant the a
plicant has read and will abide by the conditions of this exemp-
Issuing date
tion, and (2) a written statement has been obtained from adjacent
landowners certifying that they have no objections to the proposed work. Expiration date
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