Webster C Bazemore Jr

CERTIFICATE OF EXEMPTION T�k 35 I;L CI
FROM REQUIRING A LAMA PERMIT -r ' 01.5361"',
as authorized by the State of North Carolina,
Department of Environment and Natural Resources and the Coastal Resources Commission
in an area of environmental concern pursuant to 15 NCAC Subchapter 7K r 01
Applicant Name
Address h-1 Shor
City 54
Project Location (County, State
Water Body, etc.)
vx-o4 Nr,
The proposed project to be located and constructed as described
above is hereby certified as exempt from the CAMA permit
requirement pursuant to 15 NCAC 7K n i PT . This exemption
to CAMA permit requirements does not alleviate the necessity of
your obtaining other State, Federal or Local authorization.
State
Phone Number( V a )S3�7%112
Zip 7-
This certification of exemption from requiring a CAMA permit is
valid for 90 days from the date of issuance. Following expiration,
a re-examination of the project and project site may be necessary
to continue this certification.
SKETCH (SCALE: I - L1 U )
Xis
Any person who proceeds with a development without the con-
sent of a CAMA official under the 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 (1) the ap-
plicant has read and will abide by the conditions of this exemp-
tion, and (2) a written statement has been obtained from adjacent
landowners certifying that they have no objections to the
proposed work.
� /,�I1 o Itic r S 1 ,k, (D J,
X 6 3 �1h 4 dt,�"`- 1'� c�. v
in
11
H
Applicant's signature
CAMA Official's signature
Issuing date
jai, /A 5Z /7, (-
Expiration date
Attachment: 15 North Carolina Administrative Code 7K

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Applying for Permit: � J &&S TE�Z- C A A ?N ,-- C.eF— 31 Z
s vs , Z V4t o2t
Mailing address: 4109 S O-KOZCLi SIL L74 1oF;—
Phone Number:
I certify that I have authorized �-
Agent / Contractor
to act on my behalf, for the purpose of applying and obtaining all CAMA permits
necessary for the proposed development of
at my property located at ZAQ-? U AE--�- %,
in E (ZU A)S UJV CV4-- County.
This certification is valid through ` jEC&ffi(
Date
(Property Owner Information)
C'
Signature lazCr C � Z& �Yld
Print or Type Name
Title
U',vci 2I 2 01
Date
33-?- '?k 2
11 Phone Number
imad Address
Tracker
CDAITS ,
MHCDO
Tyler Crumbley
LPO
DW Review
Ownercwtii