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cant Name
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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 Subchapter 7K .0203.
Phone Number � 1 U 2120-14
State _ Zip 2 S'f
ct Location (County, State Road, Water Body, etc.)
/tj� 1W r1 iYS� - %r4t.AS -
and Dimensions of Project I. � N s t
roposed project to be located and constructed as described
is hereby certified as exempt from the CAMA permit re-
nent pursuant to 15 NCAC 7K .0203. This exemption to
a permit requirements does not alleviate the necessity of
)btaining any other State, Federal, or Local authorization.
This certification of exemption from requiring a CAMA per
valid for 90 days from the date of issuance. Following expiry
a re-examination of the project and project site may be nece!
to continue this certification.
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cant Name
ass I <q
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CERTIFICATION OF EXEMPTION
FROM REQUIRING A LAMA 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 NCAG Subchapter 7K .0203.
Lan Y\v " -) r-" i 4, Phone Number W 1-2-0-113
and Dimensions of Prood
voposed project to be located and constructed as described (bed This certification of exemption from requiring a CAMA permit
o is hereby certified as exempt from the LAMA permit re- valid for 90 days from the date of issuance. Following expiratic
went pursuant to 15 NCAC 7K M03, This exemption to a re-examination of the project and project site may be necessa
A permit requirements does not alleviate the necessity Of to continue this certification.
obtaining any other State, Federal, or Local authorization.
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NoM Carolina Depatwt of Emmment and Natural Resources
N'Sim of coasta! m"qWMI
Seventy Eaves Perdue James H, G"sm Ose Ft
Gavffw Direcix �
AGENT AUTHORIZATION FORM
Cate 12-1i-17
Name of Property Owner APPIYqrg fDr Permit Name of Authorized Agent for this protect
1,11111% tinljt',') Wit Richardson
OwnWs Ma Address:
139 Swordfish Privc
I iolden Reach NC 21462
Agents Al Ung Address
3235 Seacrest Ave SW
Supoy NC 28462
Phone Numbw(910) Pho,*Number (910, 387-0335
i cert;fy that I have aulhOnZea the agent listed above to act an my behalf, W the purpose of aoplpN
for and obtaining all CAMA Perm4s necessary to instaP or =istrud OW t6i0wing {aClWty)
(my prooen-y, located} at
i w Swordfish Drive Holden Beach NC
This oe-tWimtson is valid thni 4)
proolrty Owrw Signature
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