Charles Caravati

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 NCA Subchapter 7 OLtOor NCGS 113A-103(5)(b)(5)
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Applicant Name C &c\t• C_IA(a MA4 Phone Number
Address 13( aA u Li . .
City Algfl k3 ' State Vt Zip Z 103
Project Location(County,State Road,Water Bpdy,etc.) S 0 A .0 ..1\•km` 4.0,e‘
kkl..) -RAWO tetx 1 kS . -Ann Q
Type and Dimensions of Project V Qia" l 5` 0 ex% _14 t kle'CQd,, f * c -kc.-Iat -kS
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- I,
sent of a CAMA official under mistaken assumption that the Appli nt's signa
development is exempted, will be in violation of the CAMA if there
is a subsequent determination that a permit was required for the
•
development. CAMA ffici I's signature �j
The applicant certifies by signing this exemption that the /0 PI 18 ` Z t�` /i
applicant will abide by the conditions of this exemption. Issuing da Expir tion Date

T. .
AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION i
Name of Property Owner Requesting Permit: `,.,J09-,./ L. s R4 CA/0914)-f
Mailing Address: 9,3i P�/, )9-,D s. - ;P p
toc i , —N S, -fir)7 v1i1 21rd3
Phone Number: R. 1 r 35" 7'Qi 3
Email Address: Y ( 0 e *, i C 1 n^
I certify that I have authorized (,(.4.44„1,_ //(6‘2,4-- ,
Agent/ or
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: ;rr a ' de ;-3 4 S ril
10i,( I k l k -e c, c.., ( d- 0, did rer:k LCf-1 ,e'r� (1-;-e 1Ja.c_f<.) 1 o /'t (t-s S L<-S
p.L ^ 1
at my property located at q �aa1J-s P_d ,
in /)f=,,) //Gtic, J -, County.
I furthermore certify that I 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 In ation:
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Signature
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Print or Type Name
()LA-% ,'J e '-
Title
/ I ! r I / f2
1 Date
This certification is valid through I I

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