01634D - Azar

CERTIFICATE OF EXEMPTION 1,
FROM REQUIRING A LAMA PERMIT 01
as authorized by the State of North Carolina,
Department of Environment and Natural Resources and the Coastal ResourceISM
in an area of environmental concern pursuant to 15 NCAC Subchapter 7K L� ZS "
'1
licant Name Y ,✓_ Phone Numbe
ress ``:1-i I (bFVNVhA ue- I„ _
(Counjy, Stat"oad, Water Body, etc.)
e and Dimensions of Project
proposed project to be located and constructed as described
e is hereby certified as exempt from e CAMA permit
Arement pursuant to 15 NCAC 7K. N f � . This exemption
:AMA permit requirements does not alleviate the necessity of
r obtaining other State, Federal or Local authorization.
This certification of exemption from requiring a CAMA
valid for 90 days from the date of issuance. Following ex
a re-examination of the project and project site may be r
to continue this certification.
KETCH (SCALE: I — L0
CANIAt,
* N b in wak K
Ye! I� U
-INN kw �&
also Eb�
ricVOWA,

A W
r.pnt �tp + tttins�mr ►.twn i mpicwcr NCDENR
North Carolina Department of F*nvironment and Natural Resources
DiN ision of Coastal Martauernent
Pat McCrotN
(ns► rnOr
Braxtom (" I)a► Jahn l: Skvarla. ll1
lhrectoi Secretar%
AGENT AUTHORIZATION FORM AGENT AUTHORIZATION FORM
�•;.�
NCDENR
North Carolina Department of FAvironment and Natural Resources
Dt%rston of Coastal Management
Pat McC'rtir\
(ill► e rmor
Date
ne of Property Owner Applying for Permit:
ter's Mailing Address
1/ .__ Ct�crrtfr C'l _ �•'
ne Number,Xg 1
Braxton( t)a►John 1 Sk►aria. III
t>trectol Secrelan
Name of Authorized Agent for this project
GY; to �0'IS �f fkC A'a't
Agents Mailinp Address:
Phone Number I il0 1 �095!
lify that I have authorized the agent listed above to act on my behalf, for the purpose of applying
rid obtaining all C6/A Permits necessary to install or construct the following (activity):
1"t'�r!�LG /`ter G!nn-d CPR /aaY—k A,&e d(%r
y property located at
i100
d�3 /T
rtification is valid t u date) j 0 /
—111-7115
Pro w r nature Date

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