01570D - JFEEME

icant
•ess
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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and Dimensions of Project , Ta
roposed project to be located and constructed as described
is hereby certified as exempt from the CAMA permit
ement pursuant to 15 NCAC 7K f 1 ( . This exemption
MA permit requirements does not alleviate the necessity of
)btaining other State, Federal or Local authorization.
C
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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In Fnvelope ID: D92EB463-tA97-4lD8-9822-5D9B9F4D2C2C
CERTIFICATE OF EXEMPTION
FROM REQUIRING A LAMA PERMIT N° 015
as authorized by the State of North Carolina,
Department of Invironnient and Natural Resources and the Coastal Resources on ilssion
in an area of environmental concern pursuant to 15 NCAC Subchapter 7K �Q Q , I'll, 5 j'2' t
pplicant N e �_- ��� ..��1 (ft� 1 .p Vtkf P,) "done Number _ 54� -I
ddress�- - t1
�ity — }Z`► �_ L�l+afYl J __ _ — State _. Zip
roj`V ocation (C,Qunty, Sta Ro , Wa Ater Body, etc.) �^ --
l'1 �l,ti,/fl! I .r .I 1 ,-Y.. !k 'riZ,n<.� .�l- An / i'Y`nt�In tvti Finn 1341nittl�
ype and Dimensions of Project
ie proposed project to be located and constructed as described
ove is hereby certified as exempt From the CAMA permit
luirentent pursuant to 15 NCAC 7K 63 . This exemption
CAMA permit requirements does not alleviate the necessity of
ur obtaining 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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DoauSigned by:
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AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: _ J v.�
Mailing Address:
Phone Number: "1 S,4 — I�
Email Address:
I certify that I have authorized
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following p�ro`posed development
at my property located at (C ! � � � �, 6
County.
l furthermore certify that l am authorized to grant, and do in fact grant permission to
Division of Coastal Management staff, the Local Permit Officer and their agents to enter
on the aforementioned lands in connection with evaluating information related to this
permit application.
Property Owner Information:
Signature
Print/for Type Nam

CIO A-7