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CERTIFICATION OF EXEMPTION
FROM REQUIRING A CAMA PERMIT
as authorized by the State of North Carolina,
Department of Environmental Quality and the Coastal Resour ission in an area of
environmental concern pursuant to 15 NCAC Subchapter 7Iy r�VCGS 113A-103(5)(b)(5) .
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Applicant Name / -hone umber
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Project Location(Coun► State Road, :t .
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The proposed project to be located and constructed as This certification of exemption from requiring a CAMA permit
described above is hereby certified as exempt from the is valid for 120 days from the date of issuance. Following
CAMA permit requirements.This exemption to CAMA expiration,a re-examination of the project and project site may
permit requirements does not alleviate the necessity of be necessary 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 mistaken assumption that the pli•=n s signa re
development is exempted, will be in violation of the CAMA if there r
is a subsequent determination that a permit was required for the •
development. ? CA rffici 's sig re
4), / i applicant certifies by signing this exemption that the / J (p 4r-
The
applicant will abide by the conditions of this exemption. Issuing date Expiration Date
Letter of agent
I C) (�vl 1 r) 2, C:€--(•__ have retained Mark Clements DBA,Clements
Marine Construction Inc,to make application for any and all permits needed to start
construction on the work requested for our property or properties.
By allowing Mr. Clements to make such applications I do understand that this will in no
way relieve me of any obligations to perform all work according to the building codes of
North Carolina, CAMA,DWQ or any other state and or county ordinances.
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Print n e
Signa S 4, 414, 41Ji
70L1/ oz,Z3 date /! Z 5
Contact information
RECEIVED
DCM WILMINGTON NC
1220-KC -SOL
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