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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 15 NCAC Subchapter 71KIP3.
.0103
)plicant Name Phone Number
idress
ty State Zip
oject Location (County, tate Road, Water Body, etc.)
'pe ana Dimensions of rroject
e proposed project to be located and constructed as described This certification of exemption from requiring a CAMA i
ove is hereby certified as exempt from the CAMA permit re- valid for 90 days from the date of issuance. Following ex
irement pursuant to 15 NCAC 7K . his exemption to a re -ex mina ion of the project and project site may be ne
WA permit requirements does not
atte 'athe necessity of to continue this certification.
ur obtaining any other State, Federal, or Local authorization.
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'-er-i11 bii:55 From: Iliti PLRN&INSP 9108427003 To:19103953%4 P.1/1
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 concem pursuant to 15 NCAC Subchapter 71(-0e.
Applicant Name Phone Number
Address
sty -st ate Zin e
We Roth, Water Body, qt�, )
Typo and Dimensions of
The pmpased project to be located and constructed as described
above 4 hareby ceriffled as axempt from the CAMA permit re-
quirement pursuant to 15 NCAC 7Ke.Is exemption to
CAMA permit requirements does not the necessity of
your obtalnfng any other State, Federal, or Local authorization.
This certification of exemption from raqulrfnd a CAMA permh is
valid for 90 days fron the Cate of Issuance_ Following expiration,
a re-oxamin3tlon of Via project and project site may be necessa,-y
tc continua this cenlfication,
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Any person who proceeds with a development IMi Hoot the son-
sent of a CAMA official under rha miataknn naa nnrinn thnt*.n �J,-anl'a alnn� mn �-

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