Bumpass

I CERTIFICATION OF EXEMPTION
FROM REQUIRING A CAMA PERMIT
as authorized by the State of North Carolina,
Department of Environmental Quality and the Coastal Resources Commission in an area of
environmental concern pursuant to 15 NCAC Subchapter 7K.0/o3 or NCGS 113A-103(5)(b)(5) .
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Applicant Name f) Phone Number (o
Address (Vi0-3 CIS, 97SI-ate �y- .
City C) rV^ ^^ State J c.» zip 2 t 2-
(/( ( J( f41 -c s=f,
Project Location(Cou�ty,State Road,WategBody,etc.)
Type and Dimensions of Project 5`J-e v( to (�. k, �` J 1. c.l -- _ c k
3 Dc0 as 6,0:. • �iie i `,
The proposed project to be located and constructed as This certification of exemption from requiring a CAMA permit
described above is hereby certified as exempt from the is valid for 120 days from the date of issuance. Following
CAMA permit requirements. This exemption to CAMA expiration, a re-examination of the project and project site may
permit requirements does not alleviate the necessity of be necessary to continue this certification.
your obtaining any other State, Federal, or Local
authorization.
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Any person who proceeds with a development without the con- /''4,^c
sent of a CAMA official under mistaken assumption that the Applic nature y
development is exempted, will be in violation of the CAMA if there ,jl,� r lc' ke.....___
is a subsequent determination that a permit was required for the IF\'
development. CAMA Offi ial' signature
The applicant certifies by signing this exemption that the 3 2o2-0 ZzG��
applicant will abide by the conditions of this exemption. Issuing/at Expirat Date

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