Peter Deslove

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 AWr NCGS 113A-103 (5) (b) (5)
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ApplicantName PE ? F (Z 0C SLo t, E- Phone Number N ��
Address )14S$ CA-%r►&utJ LC^*- LT. S F ;
City �� t7f-L v1 h State Zip 2$42 2.
Project Location (County, State Road, Water Body, etc.) l 771 u a -A � Oi1AA
Type and Dimensions of Project PA , P, 67 It ' `'V G G T 1L
S'oV, .F -r%C Wit. 14&s At m 5700/. or- THE LldzexS-
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 requir' a CAMA permit
is valid for 120 days from the date of is nce. Following
expiration, a re-examination of the p ct and project site may
be necessary to continue this ce tion.
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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.

9/9I2019 Mail - Brock, Brendan O - Outlook
AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: Pew r - R � � t el
Mailing Address / 5� -�;'/ G() . -::-�A- ' 1 641r1 CJ
Phone Number:
Email Address:��}{+�
I certify that I have authorized
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:
at my property located at / 7 ( t,y . SCIA
in 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:
_
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_Signature
CTl
— _(:',e-'
Print or type Name
Title
Date
This certification is valid through ._L_/ 3 t l__L�
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9/9/2019 Mail - Brock, Brendan O - Outlook
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