HomeMy WebLinkAbout1428 Bay St LLCCERTIFICATION 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.At03or NCGS 113A-103 (5) (b) (5)
Applicant Name 1128 &1 S_( LL C Phone Number
Address 1p'h A94tim Q-AK) ;
V(V '�►457sC,3
City State fV. C • Zip 2'1104
Project Location (County, State Road, Water Body, etc.) 14 a
1��qLL CjZ(EK-
Type and Dimensions of Project CL % t'tiv FR
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 signature s
development is exempted, will be in violation of the CAMA if there
is a subsequent determination that a permit was required for the
1 N
development. CAMA fficial's signature
The applicant certifies by signing this exemption that the _01 9 %:�-�7--�u�°1
applicant will abide by the conditions of this exemption. Issuing date Expiration Date
4�
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Pat McCrory Braxton C. Davis John E. Skvarla, III
Governor Director Secretary
AGENT AUTHORIZATION FORM AGENT 'ON FORM
mr-A
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Pat McCrory Braxton C. Davis John E. Skvaria, III
Governor Director Secretary
Date: i
Name of Property Owner Applying for Permit:
��o ��; � r � t tom•
Owner's Mailing Address:
W 1".1 fur�-
2710`
Name of Authorized Agent for this project:
�'j✓' t 0�_ L-t (i'r c c-C,
Agent's Mailing Address:
(o 1 -be'c_l Dw*1sc` SW
Q cC l s I -�- i3c C-L 1J N c�
-ZS7 Ltto�
Phone Number (33�) � 17 Phone Number 11) % 1 _ Y 09 5—
I certify that I have authorized the agent listed above to act on my behalf, for the purpose of applying
for and obtaining all CAMA Permits necessary to install or construct the following (activity):
127 Cardinal Drive Ext., Wilmington, NC 28405
Phone: 910-796-72151 FAX: 910-395-3964 Internet: www.nccoastaimanagement.net
An Equal Opportunity 1 Affirmative Action Employer
For my property located at I Li Z. 'X
This certification is valid thru (date) I W jb Cex>Lt n i ��'i dYl-
1 7 1
Property Owner Signature Date
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