01581D - Camp

plicant Name
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)ject Locator
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CERTIFICATE OF EXEMPTION �'lJ<�l�
FROM REQUIRING A CAMA PERMIT Ol
as authorized by the State of North Carolina,
Department of Environment and Natural Resources and the Coastal Resources Co Isslon
in an area of environmental concern pursuant to 15 NCAC Subchapter 7K
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proposed project to be located and constructed as described This certification of exemption from requiring a CAMA I
ie is hereby certified as exempt from the CAMA permit valid for 90 days from the date of issuance. Following ex',
iirement pursuant to 15 NCAC 7K • fh-�. This exemption a re-examination of the project and project site may be n
',AMA permit requirements does not alleviate the necessity of to continue this certification.
- obtaining other State, Federal or Local authorization.
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North Carolina Department of Environment and Natural Resources
Division of Coastal M mernent
Pat McCrory Braxton C. Davis John Secn
Governor Director
ASCENT AUTHORIZ&T QN FORM
Date:
Name of Property Owner APplyfg for Permit: Name of Audww aed Ago t for this project:
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Owners MaN 9 Address:
F)o l o x IV
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Phone Number 6611) `7 DLii-9 —
I certify that I have authorized the agent listed above to act on my behalf, for the purpose of ap*N
for and obtaining as CAMA Permits necessary to instaq or construct the fol{owkV (ac#vitY):
For my property located at b S 1 S u n s et Sf 5 B a Vi i sN Q,
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