01689D - Burton

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CERTIFICATE OF EXEMPTION
FROM REQUIRING A LAMA PERMIT 01f
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
Q i
licant Name i"JI JUy+oy� Cl b H �f X �-}pVKe IY11Y�N/e rrtrt Phone Number,
L.�2-
ress IIbU� urG"�r h,-k,
and Dimensions of Project
roposed project to be located and constructed as described
is hereby certified as exempt from the CAMA permit
ement pursuant to 15 NCAC 7K . This exemption
.MA permit requirements does not alleviate the necessity of
)btaining other State, Federal or Local authorization.
This certification of exemption from requiring a CAMA pe
valid for 90 days from the date of issuance. Following expi
a re-examination of the project and project site may be nec
to continue this certification.
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AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Applying for Permit:
Mailing address:
big
Phone Number: 1q. 7 d
v
1 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 —�,�, s-rxill r�Ti n �✓ o �� u.�
at my property located at
in County.
This certification is valid through
Date
(Property Owner Information)
gnature
6/1
n' LtI t�)) -' o �
Print or Type Name
IAa Inke.o 1.0 L-k-IP—
Title