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CERTIFICATION OF EXEMPTION Qelo y/ ii
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.,
Applicant Name p,r- �.f S ( r ug w -i.: r-d Phone Number =aAddress ' / DC 4 iv e j / Q r 4 ecc ^ , ;
City C •-, i ( State /v G Zip 5 4
Project Location (County State Road,Water Body, etc.)
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Theproposed project to be located and constructed as described This certification of exemption from requiring a CAMA permit is
above is hereby certified as exempt from the CAMA permit re- valid for 90 days from the date of issuance. Following expiration,
quirement pursuant to 15 NCAC 7K .0203. This exemption to a re-examination of the project and project site may be necessary
CAMA permit requirements does not alleviate the necessity of to continue this certification.
your obtaining any other State, Federal,or Local authorization.
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CASwE4- '-- l3FAcIL /BOA J
Anyperson whoproceeds with a development without the con- --f _ _e. -r� /1W
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sent of a CAMA official under the mistaken assumption that the Applicant's signature
development is exempted,will be in violation of the CAMA if there ' 0 Ct-AAA-%.
is a subsequent determination that a permit was required for the
development. CAMA Off ic. I s sr atur-ep
The applicant certifies by signing this exemption that (1)the ap- D
Issuing date
plicant has read and will abide by the conditions of this exemp-
tion,and(2)a written statement has been obtained from adjacent L-/— - 0
landowners certifying that they have no objections to the Expiration date
proposed work.
Attachment: 15 North Carolina Administrative Code 7K.0203