01743D - Mars

CERTIFICATE OF EXEMPTION
FROM REQUIRING A LAMA PERMIT 01 i
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 --C,
licant Name Z 1 A r t Phone Number
ress jL t -i 6.,-_x?t r-�-�O o, ,
State �; Zip _1 -2
act Location (County, State Road, Water Body, etc.)
Ytj;Y'\C O t (�S./��1 1, V2-Cy-kC1 \
and Dimensions of Project i,)tJ
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 -1 ? "1" . 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.
ETCH (SCALE:
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AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Applying for Permit:
Mailing address:
2 -7--Z-012—
Phone Number: ui - CA"- 33r, G "--CIt-I
I certify that I have authorized I /j o hp s
Agen / Contractor
to act on my behalf, for the purpose of applying and obtaining all CAMA permits
necessary for the proposed development of ('_ S
at my property located at 7
in County.
This certification is valid through
Date
(Property Owner Information)
J Signature
Jfim a s It AL.t,csA 4-
Print or Type Name
&,a,, n e k--
Title
Date
Phone Number
/hoe -cab i P aA(_ i flvm
Email Address
CDaits
MHCDO
Tyler Crumbley
LPO
DW Review
Owner