General Permits (5923)

5-
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
Applicant Name �,.1 �.1,�er�cjc�r�,.;Y\\ - Phone Number q\4 "��i�- alb i
Cityt,. State c�c. --Zip _
_Project Location (County, State Road, Water ody, etc) L.lag�; �` C� = SO AJ C._ t
_ ` . .. :.
Type and Dimensions of Project G t.: ' { a
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P At S
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 for from the date of issuance. Following expiration,
uirement pursuant to This exem 'o o a re-examination of the project
exemption t ' I ct and project site may be necessary ..:
LAMA permit requirements does not alleviate the necessfty of - to continue this certification.' your obtaining any other State, Federal, or Local authorization. - -
SKETCH :. (SCALE: NON IF )
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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'rf there
is a subsequent determination that a permit was required for thePme
development.' fficial's signature
The applicant certifies by signing this exemption that (1) the ap- \C�
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 7V jqq'�
landowners certifying that they have no objections to the Expiration date
proposed work.