Brian Hargrove

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 7KQJ6'� or NCGS 113A-103 (5) (b) (5)
Applicant Name
Address"
City
Project
Type and Dimensions
an
ky,
nty, S%ate.Ropd, Water Body, etc.
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.
PhoneNumber f 4VO 5a`3_?
State Ll G Zip q o
17
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.
14
A igna
YA,
CA Official's signature
11-/2 1-13-2©
Issuing date Expiration Date

12/16/2019 Mail - Brock, Brendan O - Outlook
CERTIFICATION OF EXEMPTION
FROM REQUIRING A CAMA PERMIT
as authorized by the Slate of North Carolina,
Department of Envlronmontal Quality and the Coastal Resources Commission in an area of
environmemal concern purstiant to 15 NCAC Subchapter 71($,'J T or NCGS 113A-103 (5) (b) (5)
ApplicantName�'( an _--.---Phone Number-7 H a'n 5 '?
Address
City State..___
r
Project Lo(
Type and Dir
The proposed protect 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 nocossity of
your obtaining any other Slate. Federal, or Local
authorization.
Zip -23
This certification of exemption from requiring a CAMA permit
is valid fur 120 days from the date of issuance. Following
expiration, a re-examination of the project and projecl site may
be necessary to continue this certification.
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Any person who proceeds wAh a development without the con_
sent of a CAMA official under mistaken assumption that the Appl Ignat re
development is exempted, will be in violation of the CAMA if there / t�
is a subsequent delannination that a permit was required for the
development, CA -Official's signature
The applicant cefllftes by signing this exemption that the ld-- % 3�� _ � 3- 2. 0
applicant will abide by the conditions of this exemption. Issuing date Expiration Date
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120 3/2019
Mail - Brock, Brendan O - Outlook
AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit:9'4Q_!,�
Mailing Address: ' /� r� r�2� le-
s!� f �nyt/' z z jr , s- 4 C _ :2 S/G�
Phone Number: �L� �G ^ 2 T3
Email Address: �r'a Y.S hat 'r9!'o U(f <:�'• G �
I certify that I have authorized A1,4N/ h-e S7i�
Agent 1 Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: lYa w k
at my property located at
in c1C 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 Information:
�r ,Signature
Print or Type Name
Title
`
Date
This certification is valid through �) 1 /-D, 12,�)'
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