General Permits (5902)

,
CERTIFICATION OF EXEMPTION
FROM R•EQU,I_RING.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 Phone Number
Address -
City :State Nc—zip�
Project Loca n (County, State Road, Water Body, etc.) 2�,
Type and Dimehsions of Project
N i
The ro to be located and constructed proposed project .as described This certification of exemption from requiring
n a CAMA
permit is' --.-
above is hereby certified as exempt from the CAMA permit re- valid for gazhW from the date of issuance. Following expiration,
quirement pursuant to' • This 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
• ..i (SCALE:
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 (t) 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.
inatu
UAMA umc+ars signature b '
Issuing date
Expiration date