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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 Resours.9smmission in an area of
environmental concern pursuant to 15 NCAC Subchapter 7K r NCGS 113A-103(5)(b)(5) .
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Applicant Na p Mg 4)r" Phone Number SIS
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Address I tie_ -25 • iK 1. ,
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City 1 &i 5 PPState Zip � y`7�
Project L ,ocation(County, tate ad,Wa r Body,etc.) .f /4/344-• v • ' " fri
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Type and Dimensions of Project Lr it k. tto AI
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 fronvthe 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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11 111111 1Any person who proceeds with a development without the con-
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sent of a CAMA official under mistaken assumption that the Ap.lica is Sign.ture
11# development is exempted, will be in violation of the CAMA if there ,�
is a subsequent determination that a permit was required for the
development. C• Official's signature /�• ��`
The applicant certifies by signing this exemption that the I
applicant will abide by the conditions of this exemption. rsuing date Expiration Date
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