Stephen Blemings

( CERTIFICATION OF EXEMPTION
FROM REQUIRING A CAMA PERMIT
as authorized by the State of North Carolina,
0 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.
Applicant Name -S-r ), 1 e-critinicis Phone Number) 73'56)+14-78'53
Address '/4 0 ARrtaa RoAo
City W145.70,, 5A,.tm State /VC Zip 21o4
Project Location(County,State Road, Water Body, etc.) u S 4- Hn zr,J LAN Di/4/6 6Jy,s / Noi.pep, GEAc 1 I
A/C , ^ 2. f ,-w,nk, ; BRa4NS<11<K. C61...//11
Type and Dimensions of Project Cort$MA :.2 ' X 12 v R)OF ovc R. EV I LT,,vc, IZ' x 12'
i..-�4,.
The proposed project to be located and constructed as described This certification of exemption from requiring a CAMA permit is
above is hereby certified as exempt from the CAMA permit re- valid for 90 days from the date of issuance. Following expiration,
quirement pursuant to 15 NCAC 7K .0203. This exemption to a re-examination of the project and project site may be necessary
CAMA permit requirements does not alleviate the necessity of to continue this certification.
your obtaining any other State, Federal,or Local authorization.
SKETCH (SCALE: 2 O ' )
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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 Applicant's signature
I development is exempted,will be in violation of the CAMA if there G:-- i /�
is a subsequent determination that a permit was required for the "!A/I /"(c ,.f(,_/
development. CAMA Official's signature-//
?/30/20 ig
The applicant certifies by signing this exemption that (1)the ap- Issuing date
plicant has read and will abide by the conditions of this exemp-
tion,and(2)a written statement has been obtained from adjacent 12/3o /.2o IS
landowners certifying that they have no objections to the Expiration date
i proposed work.
r_ Attachment: 15 North Carolina Administrative Code 7K.0203

NCDENR
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
i
Date: r Y/13
Name of Property Owner Applying for Permit Name of Authorized Agent for this project:
Owner's Mailing Address: Agent's•
Address:
/��/�, � /� c 5 PPY 9vc
NL Z 5 '# 4 "L
Phone Number(J3O `1.1 14 7 S r3 Phone Number( ) 8 e G (15 8 1
I certify that I have authorized the agent listed above to act on my behalf,for the purpose of applying
for and obtaining all GAMA Permits necessary to install or construct the following (activity):
I ci 1420'6>
For my property located at 13 C`1 14 c r o_. c.
This certification is valid thru (date) `f '9kGi 2— y / ' •
C-�y�
Property Ow ignature_ Date
127 Cardinal Drive Ext.,Wilmington,NC 28405 One
Phone:[phone]\FAX:[phone] Internet:ww.nccoaslalmanagement.net NoorthCarolina
An Equal Opporlunity1 AlluNaturally
Action Employer atorally

PREPARED BY: DATE:
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