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Home My WebLink AboutIsland Park HOA . r 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 711•Olio or NCGS 113A-103(5)(b)(5) Applicant Name -.--.a Y+Ct !l ark f-/C)F Phone Number "k) --)7-i- 151.3 Address Coo-,00,w;'L doc'e tae 4t.rair, rci0; aer ;t ' ..)-i^e..-- City OLear _Ts I C Z-c c�C.,�► y State Alii Zip 2 '14 Project Location(County,State Road,Water Body,etc.) z�`x``"15 f c'oCk &It )art'c.+p;;,ie'r' _ - max, (A\ipc,.-,,c i Type and Dimensions of Project 24 ea•r S --o r, c.K1 caon? arta 4 ua.4., < O/. 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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CAMA Off'cial' signature The applicant certifies by signing this exemption that the y//L/fig is f ifJt& applicant will abide by the conditions of this exemption. Issuing date Expiration Date AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION Name of Property Owner Requesting T-siqtyt4-,Tiptic_. 4-40 A Mailing Address: C0144t.Vav'tf� 'sc( z nari -4j -," may T Phone Number: 9(e) ' S7/'' grC' 5 Email Address: GA \(j 'fl 4 — r Nkri— I certify that I have authorized '41 r, k -�AN , Agent/Contractor to act on my behalf, for the purpose of applying for and obtaining all CAMA permits necessary for the following proposed development: � R S "---4O at my property located at (16V-4414(7'N c4', -i - frt'}b% '/ (1 ' 10+11144/1 in~W-0-, t C L County, t 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: Signature Print or Type Name 1 Title ___4_J (3. / IS Date This certification is valid through / / "- /...14/9 } 9 Floats 0ojanc. I I - .- x Ia.o =at. (DT F 1 o,R--uP,g Coa "b, , � .. '._ ��Y Xk ioixkla r ' - : 1 =i{ t I I k i i i x4- r t 43, ice' :I' v j i c I t t 1`3'k t