Daughtry

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.
cant Name �j[_o-M c A(, f�"S 12\.1 Phone Number L
ess 7 (A U S 4 i.-/ ?D ) /t\i
`j rr State N c Zip 215
:ct Location(County, State Road, Water Body, etc.)
and Dimensions of Project
iroposed project to be located and constructed as described This certification of exemption from requiring a CAMA per
is hereby certified as exempt from the CAMA permit re- valid for 90 days from the date of issuance. Following expir
'rent 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.
ETCH (SCALE:
\o_ > _...

CERTIFICATION OF EXEMPTION
FROM REQUIRING A CAMA PERMIT
as authorized by the State of North Carolina,
Department of Environment,Health,and Natural Resourcos and the Coastal Resources Commission
in an area of environmental concern pursuant to 15 NCAC Subchapter 7K.0203.
Applicant Name r c--1' 4,- IL\-I Phone Numberc-i\S-"14.5 9112 L
Address Z"j !.% U ,✓,-1 a) r
City 4.V,.a 1 State t.• : `Zip?
Project Location(Courtly,State Road,Water Body,etc.)
Type and Dimensions or Project
�,.
>�..G,i [:ram Ia:iL~Ai •�•
The proposed project to be ocatae and constructed as cescnbed This certl.cation of exemption horn requiring a CAMA perm:is
above is hereby certified as exempt from the CAMA permit re- valid for 90 days from the date of issuance.Following expiration,
puiroment pursuant to 15 NCAC 7K.0203.This exemption to a:a-examination of the project and project site may be necessary
CAMA permit requirements does rot alleviate the necessity ci to continue this ceri ication_
your obtaining any other Slate.Federal,or Local authorization.
SKETCH (SCALE,
My person who proceeds with a development without the con- s
sent of a CAMA official under the mistaken assum
ption that the ,./Apf)Ix: Ys signature,
development is exempted,will be in violation of the CAMA it there
is a subsequem determination that a perms was required for the J� � " •
development. C.5MA Officiars signature
The applicant certifies by signing this exemption that C1 the
�' 8 f sung dale
pticant has read and will abde by the conditions of this exemp-
tion,and(2)a written statement has been obtained from adjacent 5 .
landowners certifying that they have no objections to the Expiration date
proposed work.
Attachment:15 North Carolina Administrative Code 7K.0203