Agee Exemption

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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. 1
Applicant Name s :r !� �•<�_c? Phone Number (3 5 Chi-- YU
Address `z' A
City ( State rJLZip ? 7 w
Project Location (County, State Road, Water Body, etc.)�a y rw
',� ft 2 _ � (t T r.i,ti lZ^ �)n6! Imo:I'a i \X lit^ a.-Rw CC_ ( lJs�llczti2 d L1'a
Type and Dimensions of Project r'A0, t R ', 4 "! 1:J cl,
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The proposed project to be located and constructed as described
above is hereby certified as exempt from the CAMA permit re-
quirement pursuant to 15 NCAC 7K .0203. This exemption to
CAMA permit requirements does not alleviate the necessity of
your obtaining any other State, Federal, or Local authorization.
This certification of exemption -from requiring a CAMA permit is
valid for 90 days from the date of issuance. Following expiration,
a re-examination of the project and project site may be necessary
to continue this certification.
SKETCH (SCALE: JJTS )
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Any person who proceeds with a development without the con-
sent of a CAMA official under the 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 (1) the ap-
plicant has read and will abide by the conditions of this exemp-
tion, and (2) a written statement has been obtained from adjacent
landowners certifying that they have no objections to the
proposed work.
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Attachment: 15 North Carolina Administrative Code 7K .0203

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: -:1P tiC.l ACA e e
Mailing Address:
Phone Number
Email Address: IM61 V S�.r-Pa &
€ certify that I have authorized
Agent 1 Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: 11twaf �Jl l
4J I , h a
at my property located at
in _ !�y�� �,i� k County.
I furthermore certify that / am authorized to grant, and do in fact grant permission to
Division of Coastal Management staff, the Local Permit Officer and their agents to enter
on the aforementioned lands in connection with evaluating information related to this
permit application.
Property Owner Information:
v
Print or Type Arne
1'�
This certification is valid through �Q l�� I

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