01782D - Powell

Dlicant
Dress _
�VN
,ject Lc
CERTIFICATE OF EXEMPTION PIPA
FROM REQUIRING A LAMA PERMIT
f iw,1S
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, by . 1
�AL hi ie 11 do t(urW t1- Lv Mfr < ACllfl i Phone Number
\,^,2��
(County, State Road,
L\ , s
er Body, etc.) _1
► u 7 GVive
tt r " % }- ( E-t I
)e and Dimensions of Project
proposed project to be located and constructed as described
e is hereby certified as exempt from the CAMA permit
Irementpursuant to 15 NCAC 7K � l;i, . This exemption
AMA permit requirements does not alleviate the necessity of
obtaining other State, Federal or Local authorization.
State
Zip
KC c
This certification of exemption from requiring a CAMA p
valid for 90 days from the date of issuance. Following exl
a re-examination of the project and project site may be ni
to continue this certification.
(ETCH (SCALE:
k; i5 W
K6PAi (Zx-Vtom, cF
F1 W Ng<, "X ' Bw-Ace
No w��alric�lilS ��
(V A CD Iilc NS ti�-.E- A VT-4 ,
r:::X�S-n(1
Ft X GD Pl
C- i- rv.
�--- cXl5nts27 `4142r a
FGimtS1 17GLk rfa(�
�Il

i�gG�a.11elk Isle} tv so

C-2-2014 12:01 FROM: TO:19103953964 P.1/6
CC61WR and Natural Resources
North Carolina Department of Environment a Jahn E. $kvaria. Ill
SecrO Y
Pat McCrory
Govemor
AGENT AUTM4RIZATIoN FORM
pate;
/--) Ld
Name of property Owner Applying for Permit:
Ownees Mailing Address' e�
Are
Email: �..—...�'
Phone
Name of Authorized Agent for this pr*ct:
�S w
Agent's Mailing Address
a
Email;
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 Permits necessary to Install or construct the following (activity):
For my property located at _ _ r , • • • -
This certification is valid 1 year from (date)

T0:19103953964 P.2/6
a,l
H-01
,lr