01504D - Griffin

CERTIFICATE OF EXEMPTION
FROM REQUIRING A LAMA PERMIT
as authorized by the State of North Carolina,
Department of Environment and Natural Resources and the Coastal Resources m fission
in an area of environmental concern pursuant to 15 NCAC Subchapter 7K b 01q) Nti _ 6;
cf GVJUicant Name 6ywin, Phone Number 0
'ess Ia. h Oc► 1iI C ;nAr _
and Dimensions of Project
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 expi
ement pursuant to 15 NCAC 7K , b ! O� . This exemption a re-examination of the project and project site may be ne(
.MA permit requirements does not alleviate the necessity of to continue this certification.
)btaining other State, Federal or Local authorization.
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North Carolina Department of Environment and Natural Resources
Division of Coastal Management
'at McCrory Braxton C. Davis
Governor Director
AGENT AUTHORIZATION FORM
Date:
i e of Property Owner Applying for Permit:
h Dm&s D -F+ rl
ivner's Mailing Address:
SUSte�'►
art' t
lone Number CZN 9 4-1- 4 7 3.2,
7 a14 5-4a 4-- "I q& I C el l
John E, Skvarla, III
Secretary
ame of Authorized Agent for this project:
�t,
Agent's Mailing Address:
(Im -b \-��tctk)q - Svc
cum\� )6�,c'sQ 1A
2lgg64
Phone Number IU) S1 q q,W, �
;ertify 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 my property located at Z a�-� -VQZCA
is certification is valid thru (date)
Property Owner Signature Date

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