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CERTIFICATION F �'���-- O 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 7K4_3 or NCGS 113A-103 (5) (b) (5)
Applicant Name t_
Address 7`a 4 1 L
Phone Number -5367 (e& � y.;SJ-
City S, x �, �S,�� State ill C Zip 2 113 rg
Project Location (County, Stag Road, Water Body, etc.)IQ
Type and Dimensions of Pro'ect `
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.
AJppllic'anV signature
CAMA Official's signature
2. tl ZC..) `7 . 18 - 2.0
Issuing date Expiration Date
312312020
Mail - Brock, Brendan O - Outlook
CERTIFICATION OF EXEMPTION
FROM REQUIRING A CAMA PERMIT
ere auewrbzad by the Slam of North Cwcfira.
DepwWnem of EfwWonnMttml Quality and the COMW Resources Corrmrssion in an am of
envitunmer" concern pummg to 15 NCAC Subl3tapmr 7K,!bg or N= 1114-103 (5) (b) fS)_-
AppllcantName (2aZ+ ,nl+O% Phone Number 3% WA ifs
Address SZ V Z
City--- tState
Ste t!G c
ZIP 1-pi 3-8Pnoject_StatpRedWateroc(:y
Type and Dhermilom of Pfgject ^ •�
� r
The proposed pr ii m r to be located and oonsbuct d as
des obed above is twebY eer1Red as exempt from the
CAMA pen. nKpAwrwrtm. This oxwnp*m m CAMA
pat miuirwrrnte does not aNaviate the rlacessity Of
your obtaining any antler Stem. Federal. or LOCH
auuwrizs*m.
This carefieedon of oxwnpkm hom requiring a CAMA permit
Is veld for 12D days from the dale d Issuance. Fdlau*V
mWeban. s ra-exalninatlon of the project and pro}act aim may
be necessary to oexnk m this owdkxdm.
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Any tlafeen who pmeseds wlel a development wNhout the con-
owd of a LAMA dkW under aNfmken aplaspWn that qte
develOpPIA"d is exempted, WIN be in violation of 111a CAMA If then
is a subsequent determination that a pernNt was squired for the
The eppNo+m Cantinas by signing this exemwil l drat the
eppNcwd will abide by the conditions of this exemption.
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CAMA 01Rctsl's signature
-,lq 2dt�, '�-Ie-zvzo
Issuing dater Expiration
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3/23/2020 Mail - Brock, Brendan O - Outlook
AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: /JI DW^
Mailing Address: _ - +:E'Lv1
nrrin f.rTir/c/
Phone Number: s
Email Address:
i certify that I have authorized A// lltOows /r(lot �7✓� �oGs�c�i7y�j�
Agent I Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development '?�s 4",
at my property located at bXl T �6 , �
in -4rRA WlC4 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:
Signature
Print or Type Name
Title
Date
This certification is valid tnrough 3 1 /S-1 2 � .
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