General Permits (4142)

CERTIFICATION OF EXEMPTION
Applicant Name
Address_
City (--),.1.',;
Project Location
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�ga�
Phone Number S1S - q'}S, _ '
Type and Dimensions of Project �a„��� _ �.o cl\rco n: r ti k { ton' �; �\ e,, �5 + k k 4 +
1, " 4 11
The proposed project to be located and constructed as described
above is hereby certified as exempt from the CAMA permit re-
quirement pursuant to *5=CA6 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 maybe necessary
to continue this certification.
SKETCH (SCALE: N)c N\ )
L t4
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N41
P/L
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.
signature
CAMA Official's signature `/
Issuing date
-:_:�\ \l\C i
Expiration date
—Attachni-ent--'15-NntT- aTa Ma-AdMpvf-=ipe-Gode 7-K--G2-&3