01690D - Stephens

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cant Name
Dss . Y . V
CERTIFICATE OF EXEMPTION _
FROM REQUIRING A LAMA PERMIT 'IT", 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
I%LS Phone Number g i
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ject oc lion (Count State Road, Water Body, etc.)
i1
e and Dimensions of Project 'Le
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 . This exemption
:AMA permit requirements does not alleviate the necessity of
r obtaining other State, Federal or Local authorization.
State
2
This certification of exemption from requiring a CAMA
valid for 90 days from the date of issuance. Following e)
a re-examination of the project and project site may be i
to continue this certification.
KETCH (SCALE: 7,c-)
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AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Applying for Permit: a�Btie_ ' 'ey 4te S
Mailing address:
Phone Number:
AC'Ue )"\fie • I w L- 2-"'.'K 15
24
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ny `
certify that I have authorized
Agent / Contractor
to act on my behalf, for the purpose of applying and obtaining all CAMA permits
necessary for the proposed development of PvAKe_1'?�j�
at my property located at I G 1 CA rJ a 1,�^-
in U),I 05L)Lafounty.
This certification is valid through
Date
(Property Owner Information)
Signature
\jAw e (�,ye_y keo S
Print or Type Name
kie