General Permits (4325)

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 16
Applicant Name rci s
Phone Number 0115 -q�D
Address 4
City StateNC_ Zip
Project Location (t��, State Road, Water Body, etc.) C �t Cam. v� pl �
Type and Dimensions of Project
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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 ccrtification of exemption from requiring a CAMA permit is
valid for 9&4*Pys 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 O N �_Z )
j
I
, .w! person wno proceeos witn a development without the con-
s nt of a CAMA official under the mistaken assumption that the
deveiopment 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-
r.'r nt has read and wi!I 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.
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licant's sig
CA3'W fficiars signature
Issuing date
Expiration date
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