David Keith

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•0103 or NCGS 113A-103 (5) (b) (5)
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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.
App ' ig t re r "
CA A Offici I's s' nature
Issuing da Expiration/Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: DAVID KEITH
Mailing Address: PO BOX 1386
ABERDEEN, NC 28315
Phone Number: 910-639-2745
Email Address:
I certify that I have authorized WILL RICHARDSON ,
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:
AND GENERAL MAINT.
PILING REPLACEMENT
at my property located at 3559 RIVER VIEW LANE SUPPLY NC 28462
in BRUNSWICK County.
1 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:
l
Signature
DAVID KEITH
Print or Type Name
OWNER
Title
11 106 / 19
Date
This certification is valid through _12 / 31 1 19

5GOPE OF WORK:
REPLAGE UP TO 10 EXISTING PILIN65
SAME LOCATION.
GENERAL MAINT.
OWNER:
DAVID KEITH
3559 RIVER VIEW LANE
SUPPLY NC, 25462
910-639-2745
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