General Permits (4335)

CERTIFICATION
-�r- 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
Applicant Name 1_ . G��\ r Phone Number
Address �
City ;� State N<— ZipQ— �1
Project Location (Coup)y, State Road, Water Body, etc.)�2
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Type and Dimensions of Project
The proposed project to be located and constructed as described
above is hereby certified as exempt from the CAMA permit re-
quirement pursuant to his exemption to
CAMA permit requirements does not alleviate the necessity of
your obtaining any other State, Federal, or Local authorization.
SKETCH
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This certification of exemption from requiring a CAMA permit is
valid fors from the date of issuance. Following expiration,
a re-examination of the project and project site may be necessary
to continue this certification.
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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 signature '
development is exempted, will be in violation of the CAMA if there
is a subsequent determination that a permit was required for the
development. C-AMA Official's signature
The applicant certifies b signing this exemption that 1 the a ^" CIZ. �C�
pp y g g p () p
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 Expiration date
proposed work.
•-At{eehment=45-Morth-r—afolina-Admia:strative-Cgde _K,9203