01744D - Campbell

CERTIFICATE OF EXEMPTION.-� I
FROM REQUIRING A LAMA PERMIT ``' Oil
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,01 OZ
icant Name ���� { ��1ZL 06 r 1 Phone Number '0 \
•ess I
L^1 State Iy ( Zip i
act Location (County, State Roal Water Body, etc.)
C M
ti ti C 8yto,
and Dimensions of Project : r e v o
roposed project to be located and constructed as described
is hereby certified as exempt from the CAMA permit
ement pursuant to 15 NCAC 7K n 1 i1-7, 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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NCDETIR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
'at McCrory Braxton C. Davis
Governor Director
John E. Skvarla, III
Secretary
AGENT AUTHORIZATION FORM
Date: - 3- 1 �-
ime Jof Property Owner Applying for Permit: Mme of Authorized Agen for this project:
�0 � &I/ //
►t2X I-. k)'f, P&x_ //
rner's Mailing AddTss. Agent's Mailin
over L b-)kp"�&
�0,0I'L� o, , n . d . -y
one Number (ti q) I qG - -�qoo Phone Number
�rtify that I have authorized the agent listed above to act on my behalf, for the purpose of applying
and obtaining all CAMA Permits necessary to install or construct the following (activity):
r-e cr, , C, v � � k yto rf
r my property located at
s ification is valid thru (date) 4-)
7
Property Owner Signature Date

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