General Permits (6668)

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 . . f v G S 1 tS-10 3 (310 (5)
Applicant Name JAme:
Address 000
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Project Location (County,
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Phone Number
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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 for 90 days 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 a viate the necessity of to continue this certification.
your obtaining any other State, Federal, o ocal authorization. Pf e•G S 115 — 10 3 (5)16)U)
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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
develojimerit 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-
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.
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Applicant's signatu
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Expiration date' /
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