01694D - Pope

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CERTIFICATE OF EXEMPTION
FROM REQUIRING A LAMA PERMIT" 01
as authorized by the State of North Carolina, I'
Department of Environment and Natural Resources and the Coastal Resources Commission
in an area of environmental concern pursuant to 15 NCAC Subchapter 7K
plicant Name i IAA Phone Number
dress i fib. 1 T
y S,�A �l State Ak Zip
)ject Location (County, State Road, Water Body, etc.) P d 16 1, a,o-� To -4--f p=(JW " we r
T
De and Dimensions of Project 1 , i / 4, ��
L'l L.�A r .J 1 .1d Lk%LIEM 1 -r pro' 0a,—S -�Q :)(a`I'
proposed project to be located and constructed as described
✓e is hereby certified as exempt from the CAMA permit
Orement pursuant to 15 NCAC 7K 02Orr . This exemption
:AMA permit requirements does not alleviate the necessity of
- obtaining other State, Federal or Local authorization.
This certification of exemption from requiring a CAMA I
valid for 90 days from the date of issuance. Following ex
a re-examination of the project and project site may be n
to continue this certification.
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144

Post Hurricane Matthew Damage
1782 Shallotte Inlet Drive, Shallotte (11/01/2016)

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Applying for Permit: JXXh a g, f a fe—
Mailing address: l782 4ftA 0#-Q itig:L W '
4�4 tte- PLC.. a� 841ro
Phone Number: 7[0 ' 4pl w - (9 (
dab A,t� u
! certify that I have authorized �-Q, t� l�i,lLS►llA �
Agent / Contractor
o act on my behalf, for the purpose of applying and obtaining all CAMA permits
necessary for the proposed development of
at my property located at 173 '2- N,Q Uo V-L
in WAV; CK County.
This certification is valid through
Date
(Property Owner Information)
Signature
(h4kf i# t?i . Pue,
Print or Type Name
&rm,A�
Title