01672D - Porter

CERTIFICATEF EXEMPTION O
FROM REQUIRING A LAMA PERMIT
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 .
icant Name
and Dimensions of Project
roposed project to be located and constructed as described
is hereby certified as exempt from the CAMA permit
ement pursuant to 15 NCAC 7K U I b� . This exemption
MA permit requirements does not alleviate the necessity of
,btaining other State, Federal or Local authorization.
G J
01-6
This certification of exemption from requiring a CAMA pe
valid for 90 days from the date of issuance. Following expii
a re-examination of the project and project site may be nec
to continue this certification.
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AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Applying for Permit: �5�(2 PO4�
Mailing address: 2 J`� TOLL AU; '
Phone Number:
I certify that I have authorized CAI/ Q (r.
AgeKt / Contractor
to act on my behalf, for the purpose of applying and obtaining all CAMA permits
necessary for the proposed development ofnoG—
at my property located at
in �(/%� �`�� County.
This certification is valid through
Date
(Property Owner Information)
Signature
e- Ar��
Print or Type Name
Title