Untitled (5)

FZ 00 DIVE
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 - 11 or NCGS 113A-103 (5) (b) (5)
Applicant Name /�����' Phone Number `41" �iT� 9'
Address 22L2 `? -W, -9ePil e;75
City State NI✓ Zip X 5
Project Location (County, State Road, Water Body, etc.)
Type and Dimensions of Project
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
development is exempted, will be in violation of the CAMA if there
is a subsequent determination that a permit was required for the
development.
The applicant certifies by signing this exemption that the
applicant will abide by the conditions of this exemption.
Applicant's signature.,._,.
r t1k1_4
CAMA Official's signature
Issuing date Expiration Date

3/2/2020
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RECEIVED
DCM WILMINGTON, NC
MAR 0 3 2020
https:Hnhcgov. maps.arcgis.com/apps/webappviewer/index. html?id=cc3a4l 687ab441 a99503a93ff8921 beb 1/1

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit:
Mailing Address:
Phone Number:
Email Address:
►•
R�6A Zav�s �i-re-l-'k,-
-4. S4-e. o� C-0--
q`Q %D� -ZCe,(�
,( CA' 0) Gi v,,,---i 1 • LOB
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I certify that I have authorized ��a S ` CJ��-c1AS''N '-t4� 0 VI\
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: Cc, -,P-
Ao d(-
at my property located at �OO�� S� STz'�L, �e
in ) lew 4('VI0County.
1 furthermore certify that 1 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 Ownet n rmati
r
Signature
Print or Type Name
Caw ✓A-'%^
Title
Date RECEIVED
DCM WILMINGTON, NC
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This certification is valid through 2 1 3 C 1 MAR 3 2020