01668D - Decker

CERTIFICATE OF EXEMPTION
FROM REQUIRING A CAMA PERMIT
as authorized by the State of North Carolina,
Department of Environment and Natural Resources and the Coastal Resources Commission
in an area of environmental concern pursuant to 15 NCAC Subchapter 7K,
licant Name ilt halteK 10 KlJLLA��Phone Number
res
iADIAtin1 u State N C; Zip
ect Lotion (County, State Road, Water Body, etc.) �� a
V VVl 0 VNC t „ o �- A A , ✓1' -, A ✓% _ i , f . or i, ✓ - C i In 1; I., r
and Dimensions of Project
iroposed project to be located and constructed as described
is hereby certified as exempt from the CAMA permit
'ement pursuant to 15 NCAC 7K . This exemption
AMA permit requirements does not alleviate the necessity of
obtaining other State, Federal or Local authorization.
0f
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 ne�
to continue this certification.
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North Carolina Department of Environment and Nail Resources
Division of Coastal Managemrit
Beverly Eaves Perdue James H. Gregrn
Governor DirOCIW
AGENT AUTHORIZATION FORM
Dane: 7 -1
Name of Property Owner Applying for Permit Name of Authorind Agent for this prof+
7CAn
owner's Mailing Address
Phone Number
Agent's AdaiUng Address:
Phone Number 1 L) � („`) —(,.S , `
I csdify that 1 have authorized the agent listed above to act on my behalf, for the Purpose of applyf
for and obtaining all LAMA Permits necessary to install or construct the following (activity)'
/�A
7 L \ I . I --�) - nr1 • _ L -.I- -ice - I
(mY Property located) at
This certification is valid thru (date)
Property Owner Signature Date

Canal
NORTH
Existing Float
xisting 16x24 stationar dock
- - � Replace da
Tom and Jane Decker
204 Greensboro St