Summer Place POA

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 7ILO110 or NCGS 113A-103(5)(b)(5) .
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Applicant Name - mL( ` j,4(�P Fbft . Phone Number (ito) 30c" 6474-
Address 2-4414.52-4414.5C vv onmC,r P1&C,e Dr. SL- ;
City ti l y State -C Zip 2 8461
Project Location(Cou nty,State Road,Water Body,etc.) _'Ute` \c,c P,6-e-f --)'`�b�v` "LR
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Type and Di ensions of Project . , •` ` a - AnCA'�PTN. S(alc, and C1�pl.&C.(
LTJ A;n �-V\ ' a rn.Q •o k-p.riyx4 n r4A.i 5 t k 144' t;.a n._.c-c 4f S10-10.
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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Any person who proceeds with a development without the con- , 4-2._____-',...-,--------
sent of a CAMA official under mistaken assumption that the plicant's sig t:
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is exempted, will be in violation of the CAMA if there _
is a subsequent determination that a permit was required for the
development. CAMA Official's signature
The applicant certifies by signing this exemption that the 6f/'7//g IObi/fl
applicant will abide by the conditions of this exemption. Issuing date Expiration Date

lirNA
NCDfft
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue Braxton C. Davis Dee Freeman
Governor Director Secretary
AGENT AUTHORIZATION FORM
Date: 5-
Name
Name of Property Owner Applying for Permit: Name of Authorized Agent for this project:
Pt- Poll •
Owner's Mailing Address: Agent's Mailing Address:
L4� c 5 41-en PLA-(r on- S ")
Su( P7 1 ,
Phone Number f7/6 3D9- b 7 27 Phone Number )
I certify that I have authorized the agent listed above to act on my behalf,for the purpose of applying
for and obtaining all CAMA Permits necessary to install or construct the following (activity):
For my property located at 5 u ril 144,t PLIC,( A(2_ 5 ►- ' C .i-tJ
This certification is valid thru (date)
Property Owner Signature Date
`— e.5
112-e 5, 5,.. .�..�.t PL# tr p. /
127 Cardinal Drive Ext.,Wilmington,NC 28405 One
Phone:[phone] FAX:[phone] Internet:www.nccoastalmanagement net No hC}arolina
An Equal Opportunity ti Alhrrnatire Action Employer ,Naturally aIIy

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