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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 7K .0203.
icant Name L HAkt_ki.
'ess i 74;�
N I j2T�
,ct Location (County, State Road, Water Body, etc.)
, aria uimensions or rrofect
>roposed project to be located and constructed as described This certification of exemption from requiring a CAMA pei
e is hereby certified as exempt from the CAMA permit re- valid for 90 days from the date of issuance. Following expir
ment pursuant to 15 NCAC 7K .0203. This exemption to a re-examination of the project and project site may be nece
A permit requirements does not alleviate the necessity of to continue this certification.
obtaining any other State, Federal, or Local authorization.
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LOW-TION OF PROJlEwC'f:
PROPERTY OWNER M4ILJNG ADDRESS,:
PHONE NO.' �''� 1- 3 / -7"7']
AUTHORIZED AOINT MAILING ADDRM:
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Sign Iturt of AJthcxi.,:d'Agenl: