General Permits (532)

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Applicant Name
Address I "f
City
Project Location
CERTIFICATION OF EXEMPTION0111,
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 1.5_,N-G4C 3ubchapWr —7 .U29-3.
ii State
unty, State Road, Water Body, etc.) o44 rJC
Phone Number:`-;,D- i c) ? - I c�
Zip�i
Type and Dimensions of Project r-e, pbnck GZ nA C,c
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 1-5416AO TKO 0203 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.
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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
development is exempted, will be in violation of the CAMA if there
is a subsequent determination that a permit was required for the
l 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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Issuing date
Expiration date
Attachment: 15..NorthGaralina-Adm.imistrative=GD