HomeMy WebLinkAboutUntitled (4)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+oio3 or NCGS 113A-103 (5) (b) (5)
Applicant Name JI NOK AS oR-s NA w Phone Number N /A
Address Z 143 14or- i ftAt V-y ;
City CNARIrcT-rT State Al Zip .2W
Project Location (County, State Road, Water Body, etc.) 10 (t0 A 0 f I'` A-rr_y` S-T
Type and Dimensions of Project ,T".. —
< 50 % otr FcoA-r#,V N DoCV-
The proposed project to be located and constructed as
described above is hereby certified as exempt from the
CAMA permit requirements. This exemption to CAMA
permit requirements does not alleviate the necessity of
your obtaining any other State, Federal, or Local
authorization.
This certification of exemption from requiring a CAMA permit
is valid for 120 days from the date of issuance. Following
expiration, a re-examination of the project and project site may
be necessary to continue this certification.
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Any person who proceeds with a development without the con-
sent of a CAMA official under mistaken assumption that the
Applicant's gnatu�re,�...+
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'900Fsignature
The applicant certifies by signing this exemption that the
2,n, 2-10
applicant will abide by the conditions of this exemption.
Issuing date Expiration date
N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date I `L . I-L-31)3
Name of Property Owner Applying for Permit:
Mailing Address:
C�4C
I certify that I have authorized (agent) t ; C4�;v, Mcrin, Cvnr „��,�� to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity) � v
at (my property located at) 16 1 w Qtar
This certification is valid thru (date)
2/-L3
Property Owner Signature Date