Gandy

s
CERTIFICATION OF EXEMPTION
FROM REQUIRING A CAMA PERMIT
as authorized by the State of North Carolina,
Department of Environment, Health, and Natural Resources and the Coastal Resources Commission
in an area of environmental concern pursuant to 15 NCAC Subchapternn7Kl` .0203.
licant Name c, k- Valid �- - V1�Y ��Ptlone Number 13
JI
ress
\ State Z,ip
ect Location (County, State Road, Water �ody, etc.) 0�! w&
e and Dimensions of Project
proposed project to be located and constructed as described This certification of exemption from requiring a CAMA pE
ie is hereby certified as exempt from the CAMA permit re- valid for 90 days from the date of issuance. Following expi
�ment pursuant to 15 NCAC 7K .0203. This exemption to a re-examination of the project and project site may be nec
1A permit requirements does not alleviate the necessity of to continue this certification.
obtaining any other State, Federal, or Local authorization.
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Nov081703:42p DMG
RECEIVED 11/08/2017 03:11PM
7043604454 p.1
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WA
Nor!ro Carolina DeDartrrent of E-^vlronment and NaWral Resources
N C. Civistor of Coastam Management
John E.
S
AGENT AUTHORIZATION FORM
pate //-10-/7
Name of Property Owner Applying for Permit Name of Authorized Agent for this prger
l:-, 51116 ►' ----
Owners Mailing Address Agents Wglfin9 Address_
Erna'' �i����G ��� �`' _� Email
Prone
zen!ry that I have authorized the agent !stec above to act of -ny behalf. for the purpose of applyin
for and obtaining all LAMA Permits necessary to install or construct the fotlownng (activity)
For my property located al 1�7 �f�7'///Z�r'��/�//S' ��jj��� (.v:S�%"
Th:s certdtcabon is valid 1 year from (date)

Ox McCrory
_ 'ver'gr
North Carolina Department of E^wronment and Natural Resources
N C Divisior of Coastal Management
AGENT AUTHORIZATION FORM
Date \\- �- 11_
John E
see
Name of Property Owner Apa� ing for Permit Name of Authorized Agent for this protec
/S" /� . I �Ii iris
Owner's Malting Address Agent's Mailing Address:
Phone
Email ,Ti . Ylu.I .
Phone
i :ertdy that I have authorized the agent listed albove to act on my behalf for the purpose of applym(
for and obtaining all CAMA Permits necessary to install or construct the following (activity)
For my property located at