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CERTIFICATE OF EXEMPTION
FROM REQUIRING A LAMA PERMIT
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 i,
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,cant Name J .��Y, cPhone Number
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State
;ct Location (County, State Road, Water Body, etc.
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and Dimensions of Project bl A 4 S QVttAA � uvt Ot -1 rcVk"y, \" LlS
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-oposed project to be located and constructed as described
is hereby certified as exempt from the CAMA permit
�ment 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 pei
valid for 90 days from the date of issuance. Following expir
a re-examination of the project and project site may be nec
to continue this certification.
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N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
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Name of Property Owner Applying for Permit:
Mailing Address:
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I certify that I have authorized (agent) A# OW11AS (l� 61-6 an< to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (
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at (my property located atr. 2m6?aIr 0!e1C./''
This certification is valid thru (date)
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