EX - Ingalsbe, Franz

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 1 aL .Tv c I S.It.>r- Phone Number
Address �(_e
City
Project Location
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.
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.
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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 O di I's signature
51-? 9 12_'Sc
Issuing date Expiration Date