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CERTIFICATE OF EXEMPTION
FROM REQUIRING A LAMA PERMIT T'
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 . ,�-
icant Name .
.ess H �6 J
and Dimensions of Project
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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 exph
�ment pursuant to 15 NCAC 7K . This exemption a re-examination of the project and project site may be nec
MA permit requirements does not alleviate the necessity of to continue this certification.
obtaining other State, Federal or Local authorization.
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North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Pat McCrory Braxton C. Davis John E. Skvarla, III
Governor Director Secretary
AGENT AUTHORIZATION FORM
Date:
Vame of Property Owner Applying ermit: ame of Authorized Agent` for this project:
3wner's Mailing Address:
'hone Number f L—:r(aj, O 'ca3?�fJ
Agent's Mailing Address:
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Phone Number (Ch6 )5_7Ci'(40 cA S7-
certify that I have authorized the agent listed above to act on my behalf, for the purpose of applying
or and obtaining all CAMA Permits necessary to install or construct the followin 4activity):
'or my property located at \kN__1 T\J�GI U` I., T_!tacto 1
"his certification is valid thru (date) , �6 \0 Cam (A- t
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Property Owner Signature Date

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