01618D - Rowland

CERTIFICATE OF EXEMPTION Vv, �� ���1_
FROM REQUIRING A LAMA PERMIT 01
as authorized by the State of North Carolina,
Department of Environment and Natural Resources and the Coastal Resources o ission
in an area of environmental concern pursuant to 15 NCAC Subchapter 7K 0 ,
icant Name kAl L,K11W I OLAC� 0 Y]a C. KS"c,� oPhone Numbers q-qo
re
W�-e t M State Zip
ec LocatioP (Coy�9ty, State Fjoad, Water Body, etc.) � '
and Dimensions of Project
proposed project to be located and constructed as described
e is hereby certified as exempt from the CAMA permit
irement pursuant to 15 NCAC 7K,,,n1 V3 . This exemption
AMA permit requirements does not alleviate the necessity of
obtaining other State, Federal or Local authorization.
This certification of exemption from requiring a CAMA
valid for 90 days from the date of issuance. Following e)
a re-examination of the project and project site may be i
to continue this certification.
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NCDEWIR
North Carolina Department of Environment and Natural Resources
Division of Coastal Managernent
at McCrory BraxtwQ-4)avis
Governor Director
John E. Skvarla, 11
Secretary
AGENT AUTHORIZATION FORM AGENT AUTHORIZATION FUKM
Date:
me of Pro erty Owner Applying for Permit:
rner's Mailing Addres
y� vV r J
one Number( )
Na a of Authgrized Agent or this project:
rlc t,''1
A ent's Mailing Addr ss:
car ��� S L.J
_UIiUn nu 10:J1auCf)/V(
Z
Phone Numbera"7q--,V( S
.rtify 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 construct the following (activity):
my property located at
T
is valid thru (date) __L4f
Property Owner Signa;dire Date