Village of Bald Head Island

CERTIFICATION OF EXEMPTION
FROM REQUIRING A CAMA PERMIT
as authorized by the Slate of North Carolina,
Department of Environmental Quality and the Coastal Resourc s otnmisston In an area of
environmental concern pursuant to 15 NCAC Subchapter 7KTor NCGS 113A-103 (5) (b) (5).
Applicant Name
Address It, 1i
city - _
Project Location (County, State
etc.
State
Phone Number
Type and Dimensions of Project - - t ^
The proposed project to be located and constructed as
described above Is hereby certified as exempt from the
CAMA permit requirements. This exemption to CAMA
permit requirements does not alleviate the necessity of
your obtaining any other State, Federal, or Local
authorization.
Zip I
This certification of exemption from requiring a CAMA permit
is valid for 120 days from the date of issuance. Following
expiration, a re-examinatlon of the project and project s.te may
be necessary to continue this certification_
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Any person who proceeds with a development without the con-
sent of a CAMA official under mistaken assumption that the Appl
development Is exempted. will be in violation of the CAMA If there
Is a subsequent determination that a permit was required for the
development CAMA O Icl
The applicant certifies by signing this exemption that the Z77IQ
appifcant will abide by the conditions of this exemption Iss date