01638D - Marion

>licant
FL'
ject
CERTIFICATE OF EXEMPTION
FROM REQUIRING A LAMA PERMIT
� � 9 dD A6
T Oil
as authorized by the State of North Carolina,
Department of Environment and Natural Resources and the Coastal Resources Co missio
in an area of environmental concern pursuant to 15 NCAC Subchapter 7K ��, C� 0
Phone Number C
ie and Dimensions of Project
proposed project to be located and constructed as described This certification of exemption from requiring a CAMA p
e is hereby certified as exempt from the CAMA permit valid for 90 days from the date of issuance. Following exr
rement pursuant to 15 NCAC 7K (\� t,2 . This exemption a re-examination of the project and project site may be of
kMA permit requirements does not alleviate the necessity of to continue this certification.
obtaining other State, Federal or Local authorization.
:ETCH (SCALE: Z�
M Af-sV-+
xk 5osci
�, n ►,� -
* � b W NO'Ac�
5+v' lMy\u U
"Z-MSA 6-KJ5 a re
:IvU �M��t1CG�u`�
24,9
,� Ina�x�urk

NCDE�IR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
'at McCrory Braxton-S.-Davis
Governor Director
John E. Skvarla,
Secretary
AGENT AUTHORIZATION FORM AGENT AUTHORIZATION FuKM
Date: 6 - 6 - L5'
ime of Property Owner Applying for Permit: ame of Authorized Agent for this project:
at h i t i c- Con
vner's Mailing Address:
(i �U.RA 1y a aU-N e LQfRx
C 2.7
ion e Number A 9) *4O 4- 0 S5 7
Agent's Mailing Address:
Phone Number
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 co struct the following (activity):
,r my property located at
is certification is valid thru (date) uA4� `
2. - --0Z82La2�— ) �-- 6 -3-IS
roperty Owner Signature Date

'.?
un
I
Gaon
..
_ -,fig_ .` �.��.�., _ � � ' -
�
{ �� •
rYr� Tr
. i�11111���• --..:�
.�":
......
.�. i

v
O i >
a,
q �1.
a%4 lkl*
-VA) Vv) cx C- -k 6 r-�