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ilicant Name _
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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.
ject Location (County, State Boad, Water Body, etc.)
e and Dimensions of Project
proposed project to be located and constructed as described
ie is hereby certified as exempt from the CAMA permit re-
=ment pursuant to 15 NCAC 7K .0203. This exemption to
4A permit requirements does not alleviate the necessity of
obtaining any other State, Federal, or Local authorization.
Phone Number Z-43
State
Zip
This certification of exemption from requiring a CAMA pe
valid for 90 days from the date of issuance. Following expi
a re-examination of the project and project site may be nec,
to continue this certification.
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