01651D - McKinney

,licant Name
Ires
Ie j �t tTocatio
CERTIFICATE OF EXEMPTION
FROM REQUIRING A LAMA PERMIT
oil
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
( �' Gt K . Phone Number ( 39c, "
, State Road, Water Body, etc.)
e and Dimensions of Project
A
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proposed project to be located and constructed as described
e is hereby certified as exempt from the CAMA permit
rement pursuant to 15 NCAC 7K I (d 1, This exemption
kMA permit requirements does not alleviate the necessity of
obtaining other State, Federal or Local authorization.
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This certification of exemption from requiring a CAMA p
valid for 90 days from the date of issuance. Following exp
a re-examination of the project and project site may be ne
to continue this certification.
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AGENT AUTHORIZATION FORM AGENT AUTHORIZATION FuKivi
Dat( �64WN�bIS
Wme Prope y O,�vner A p ng for Permit
Owne 'IIALm ZMAA
Addres:
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Phone Number -
Name of Authorized Agent for this project:
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Agent's Mailing Address:
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v ►mn7,6e 16ectich he —
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Phone Number (Rik) 5 -jc(- ct0 q5
I certify that 1 have authorized the agent listed above to act on my behalf: for the purpose of applying
for and obtaining all LAMA Permits ne
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For my property located at
to install or construct the following (activity):
This certi ation is valid thru (date)
Pro erty Owner ignature to

CDa its
MHCDO
Tyler Crumbley
LPO
DW Review
Owner��c � g