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icant Name
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CERTIFICATE OF EXEMPTION
FROM REQUIRING A LAMA PERMIT z 01L
as authorized by the State of North Carolina, &lCl�
Department of Environment and Natural Resources and the Coastal Resources Commission c110 \ Z 31
in an area of environmental concern pursuant to 15 NCAC Subchapter 7K , c. ; >.
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roposed project to be located and constructed as described This certification of exemption from requiring a CAMA pe
is hereby certified as exempt from the CAMA permit valid for 90 days from the date of issuance. Following expi
ement pursuant to 15 NCAC 7K . This exemption a re-examination of the project and project site may be ne(
.MA permit requirements does not alleviate the necessity of to continue this certification.
)btaining other State, Federal or Local authorization.
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North Carolina Department of Environment and Natural Resources
DMsbn of Coastal Manager wnt
Pat Mccray BoOm C. Davis ,bls
Govew Difaft
AGENT AUTHORIZATION FORM
Date: t Z z Zd \f
Name of Property Owner Applying for Permit: Name of Audwd aad Agent for this prc
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Owner's /wig Address:
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Phone Number 3 % Z
I certify that I have authorised the agent listed above to act on my behalf, for the purpose of apt*
for and obtaining ad CAMA Permits necessary to kwW or oonsb d the foN mkV (cy):
For wry Foparty kaged at ZG a
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