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CERTIFICATION OF E TION
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
Na
In an area of environmental concern pursuant tto15 Nle
AC Subchapter 7K .020;r.
Applicant 'me f c7w+l o . 15 +'%1 e % � I T-, Phone Number V — b J S—C)
z
Address ` 7
City, f' M Zi c State -
Project' tti G Zip
Location (County;rState Road, Water Body, etch
Type and Dimensions -of Project r
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 g0 days from the date of issuance. Following expiration,
quirement pursuant to 15 NCAC 7K .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.
SKETCH ' .; (SCALE: )
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