01544D - Gregson

CERTIFICATE OF EXEMPTION
FROM REQUIRING A LAMA PERMIT 01.
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
licant Name '1-6N�i MOV d 601)\U S bV k ��—(,.AL) 9 �t Phone Number
ress -/ I I � (' `-i
Sb 0.7 State IJ Zip
ect Location (County State Road, Water Body, etc.) C o �
1j�-�
i < A�l P . v\ R -f "'4[�-A A� i 0,Ulvi w W t A
and Dimensions of Project i"-e'0 z�'
proposed project to be located and constructed as described
e is hereby certified as exempt from the CAMA permit
irement pursuant to 15 NCAC 7K 1 nZ . This exemption
MA permit requirements does not alleviate the necessity of
obtaining other State, Federal or Local authorization.
Vv\6ti-(A
��`�rn S ASS U c� �✓ 1- 1 �
This certification of exemption from requiring a CAMA
valid for 90 days from the date of issuance. Following ex
a re-examination of the project and project site may be r
to continue this certification.
KETCH (SCALE:
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AMMA
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North Carolina Department of Environment and Natural Resources
Division of Coasts! Managerrrent
Pat McCrory BMxIon C. Davis John
Governor Dkedor
AGENT AUTHORIZATION FORM
Date: fJ aA I
pwrwr AP*ft for Permit Name of AUUwA�d AOMA fqr is Pr'
Name of Property C o� �I �S
v /�
Owner's Af 9 Address:
_ ) G / vV-y / 0 1
s h C �`7YtZ
Phone Number UZ) 401 - /5 05E
I c ertif)I that i have authorized the agent listed above to ad on my behalf, for the purpose of apl
for and Otaining al CAMA Permits necessary to install or construct the bkpA g (activity):
For my property loeaisd at
This certincafion is vam thru (date) A&V I aVI (,�z
�VoII/�l�/s
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