Hensel, Dick

.�s�'gr.
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 t5-NCA(SobehteF�r?kG�fh'a3»
Applicant Name �� "t e o Phone Number
Address ot
City 016 a-r, State Al e . zip Z".-a5'
„1
14
Any person who proceeds with'a development without the con- Asent of a CAMA official under the mistaken assumption that the Appli signature
development is exempted, will be in violation of the CAMA if there f
4 : is a subsequent determination that a permit was required for the
development. CAMA Off jal'Is signature
The applicant certifies by signing this exemption that (1) the ap- Issuing date
k plicant has read and will abide by the conditions of this exemp-
' 'lion, and (2) a written statement has been obtained from adjacent 'Y /it � 20 / �
landowners certifying that they have no objections to the Expiration date
proposed work.
�; Attachment: #5idar#h-E;arolirva.AcirP�r �FE-F3283-.

A.,;ERTIFICATION OF EXE,IMPTION
FROM REQUIRING A CAMA PERMIT
as authorized by the State of North Carolina,
RiResources Commission
Department of Environment,
9nt, Health, and Natural i esources and the Coastal
in':an area of environmental concern purs6ant to 15 NCAC Subchapter .M.0203,
e,
Applicant Name Phone Number
Address
City State ZIP
Project Location (County, State Road, Water Body, etc.)
-_J
Type and Dimensions of Project -.4,
The proposed project to be located and constructed as described
-above is hereby certified as exempt from the CAMA permit re-
quirement. pursuant to 1:5--,NCAC­7X4203r This exemption to
CAMA'permit r6quire;ie�ontsVdoes, o'ynot fvTFa-t'e'!%-6�'-necessity of."
your obtaining any. other State, Federal,.or Local authorization.
SKETCH
are
This certification of exemption from requiring a CAMA permit is
valid for 90 days from the date of issuance, Following expiration,
a re-examination of -the project and project site may be necessary
to continue th,.is!'certific-at.ion.
(SCALE:
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Any'.pers , on who proceeds with a development
eveldpment without t.h a don -
sent, o*f.a CAMA .off official Under the mistaken assumption that the Ap
development is.exerripted, will -be in violation of the CAMA if there
is a subsequent d6termination that a permit was required for the : AM
development. CA I
The -applicant certifies by.signin.g this exemption that (1) the ap-
Issutnc
Olicant has read and Will abide by the. conditions'of this exG'MP-
-tion, and (2)-a written statement has been obtained from adjacent
iiature
p,signature
landowners certifying that. they have. no objections. to the Expiration datia',
proposed-work.
t-5-North-Carolina�Administrative-Gode-7K-.,020.3,-