01559D - Warren

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cant Name
ess 14
CERTIFICATE OF EXEMPTION 0151
FROM REQUIRING A CAMA PERMIT
as authorized by the State of North Carolina,
Department of Environment and Natural Resources and the Coastal Resources Co fission
in an area of environmental concern pursuant to 15 NCAC Subchapter 7K 0 b ,
/ I Ail t h i.. 1/1 \ . Dhnnn nhimhar
!ct Location (County, State
and Di
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`t C?. This exemption
,MA permit requirements does not alleviate the necessity of
)btaining other State, Federal or Local authorization.
FTCH
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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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CDENR
North Carolina Department of Environrnerrt and natural Resources
Division of Coastal jianagempnt
McCrory Braxton C. DavisJohn E. Skvarla;
overnor
Dire,:_,, Secretary
AGENT AUTHORIZATION FORM AGENT AUTHORIZATION FUKIV
Date: ! ! _ M
ne of Property Owner Applying for Permit: Z7re of Authorized Agent for cnrs Droie4
ner's Mailing Address. li/
- i c 2. S�,
one Number i-3,36 fie e
Agent's Mailing Address:
5��11k 1�C. �{(0
Phone Number Qt (b ) 5
�rtifv that I have authorized the agent listed above to act on my behalf, for the purpose of applying
and obtaining all CAMA Permits necessary to install or construct the following (activity):
r-
r my property located at % 7 ►'< ` S f c c �: k k �c74 TI U
is certification is valid thru (date) / 2 r ?�
1
Property Owner Signature
Date

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