General Permits (5908)

CERTIFICATION OF EXEMPTION
FROM REQUIRING A CAMA PERMIT
.f
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 'f
Applicant Name `' c Phone Number Q1q -D9 - : yy
Address 204 " W
,.r
city State x i Zip
Project Location County, State Road Wateri3ody etc)
Type and Dimensions of Protect �-;f� ,�� -G A'
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The proposed project to be located and constructed as described This certification of exemption from requiring a CAMA permit is
above Is hereby certified as exempt from the CAMA permit re valid forte's ffrom. the date of issuance: Following expiration;
'"gGir"ement"�iirstn'at'it`t'a , '� _, .'ftii§`�ez�mptiah��'o-```'�"'` ``a re`e�'afiifnatio`'ri ofthe'project and�rofe"ct$ite may be nece��ary `""-
CAMA permit requirements does not alleviate the necessity of . " to _continue this certification. .
your obtaining any other 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 gnature
development is exempted, will be in violation of the CAMA if there
is a subsequent determination that a permit was required for the _ ��Vy\
development. CA A Official's signature
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 Expiration date
proposed work.