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CERTIFICATE OF EXEMPTION
FROM REQUIRING A LAMA PERMIT all
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 • O 10 .
>licant Name V -" ✓ CR,lumber G C
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r State Zip 7
ject Locatipn (County, State Road, Water_Body, etc.) C C a+r d a t
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e and Dimensions of Project
)roposed project to be located and constructed as described This certification of exemption from requiring a CAMA p,
is hereby certified as exempt from the CAMA permit valid for 90 days from the date of issuance. Following exp
rement pursuant to 15 NCAC 7K . This exemption a re-examination of the project and project site may be ne
kMA permit requirements does not alleviate the necessity of to continue this certification.
obtaining other State, Federal or Local authorization.
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Pat McCrory
Governor
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North Carolina Department of Environment and Natural Resources
N.C. Divi
AGEN
. Date:
Name of Property Owner Applying for Permit
Owner's Mailing Address:
Email:
Phone
John E. Skvarl<
Secretary
Name of Authorized Age, It for this project:
Agent's Mailing Address:
9,0 s
Email: 17pc
Phone -
I certify that I have authorized the agent listed above to act on my behalf, for the purpose of applying
for, and obtaining all CAMA Permi%necessary to install or construct the following (activity):
For my property located at
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This certification is valid 1 year from (date) 7-2-f 1co

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