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CERTIFICATION OF EXEMPTION
FROM REQUIRING A CAMA PERMIT
as authorized by tho Stale of North Carolina,
Department of Environmental Quality and the Coastal Resources Commission in an area of
environmental concern pursuant to 15 NCAC Subchapter 7 2e 41 NCGS I I3A-103 (5) (b) (5)_
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Address_ %O t C�pld S (2� D rv\p .
City r--ry l3 State % 94 Zip
PrOJectLocation(County, State Road. WaterBody, etc.) lootdsbera bft" I 13
Type entl Dimensions of Project
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The proposed proloctto be located and constructed as This conihce0on of exemption from requiring a CAMA permit
described above is hereby certified as exempt from the is valid for 120days from the dale of Issuance. Following
CAMA permit. requirements. This exemption to CAMA expiration. are-examinalbnof the project and project site may
permit requirements does not alleviate the necessity of be necessary to continue this certification.
your obtaining any other stela. Federal, or Local
authorization.
Curt Welychert
Field Representative
pilakil of Coastal Managemem
400 commerce Avenue
Macnesd CnY• I.`c 2a557
252140.9497M
iCurl.wevchenOmdenr."
wwwdeq.nc.9ov
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Any who proceeds with a development without the con-
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person
sent of a CAMA official under mistaken assumption that the
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development Is exempted, will be In violation of the CAMA r (hero
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Is a subsequent determination that a permit was required for the
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development.
The applicant certifies by signing this exemption that the
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applicant will abide by the conditions or [his exemption.
Issuing date Expiration
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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 7Ki or NCGS 113A-103 (5) (b) (5).
Applicant Name
City
Project Location (County, State Road, Water Body, etc.)
Type and Dimensions of Project
The proposed projectto be located and constructed as
described above is hereby certified as exempt from the
CAMA permit requirements. This exemption to CAMA
permit requirements does not alleviate the necessity of
your obtaining any other State, Federal, or Local
authorization.
Phone Number
State
ME
This certification of exemption from requiring a CAMA permit
is valid for 120 days from the date of issuance. Following
expiration, a re-examination of the project and project site may
be necessary to continue this certification.
AEC(S): SCALE:
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Any person who proceeds with a development without the con-
sent of a CAMA official under mistaken assumption that the
development is exempted, will be in violation of the CAMA if there
is a subsequent determination that a permit was required for the
development.
The applicant certifies by signing this exemption that the
applicant will abide by the conditions of this exemption.
Applicant's signature
CAMA Official's signature
Issuing date
Expiration Dale
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 _ or NCGS 113A-103 (5) (b) (5).
Applicant Name
City
Project Location (County, State Road, Water Body, etc.)
Type and Dimensions of Project
The proposed project to be located and constructed as
described above is hereby certified as exempt from the
CAMA permit requirements. This exemption to CAMA
permit requirements does not alleviate the necessity of
your obtaining any other State, Federal, or Local
authorization.
Phone Number
State
Zip
This certification of exemption from requiring a CAMA permit
is valid for 120 days from the date of issuance. Following
expiration, a re-examination of the project and project site may
be necessary to continue this certification.
AEC(S): SCALE:
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Any person who proceeds with a development without the con-
sent of a CAMA official under mistaken assumption that the
development is exempted, will be in violation of the CAMA if there
is a subsequent determination that a permit was required for the
development.
The applicant certifies by signing this exemption that the
applicant will abide by the conditions of this exemption.
Applicant's signature
CAMA Official's signature
Issuing date
Expiration Date