Michael Miller

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 7K . 010tr NCGS 113A-103 (5) (b) (5)
Applicant Name Mte11AEt. K"r-tL PhoneNumber(914,)451-1%zi
Address 15& 6V-C JS�avto STP-r-r�T ;
City pot orn, 19EA CN State /✓e Zip 2 g4 re 2
Project Location (County, State Road, Water Body, etc.) r%RU JJSwre.r- C%)w.,Ty —C.JWAL
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Type and Dimensions of Project
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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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person who proceeds with a development without the con- :A
of a CAMA official under mistaken assumption that the Applicant's signature
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 Official'r.Zgnature %
The applicant certifies by signing this exemption that the sh 0/ 1 9
applicant will abide by the conditions of this exemption. Issuing date Expiration Date

t
127 Cardinal Drive Ext., Wilmington, NC 28405
*one:910-796-7215': FAX: [phone]Intcmet: www.nccaastalmunagcnunt.nct
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Ao Equat Oppwmwt� NC ETR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Pat McCrory
Governor
Braxton C. Dai John E. Skvarla, III
Director Secretary
AGENT AUTHORIZATION FO—RM AGENT AUTHORIZATION FORM
&WA
NCDMR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Pat McCrory
Governor
Date: vhzb�
Braxton C. Day John E. Skvarla, I II
Director Secretary
Naw,e of Property Owner Applying for Permit: Na a of Autho ' ed Agent foq this project:
Q,t1�fct
Owner Address: 6%- Agent's&m M CV re(-Su�
Phone Number Phone Number Ate)C�.-C� J
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):

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