01620D - Schofield

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CERTIFICATE OF EXEMPTION
FROM REQUIRING A LAMA PERMIT 01 1
as authorized by the State of North Carolina,
Department of Environment and Natural Resources and the Coastal Resources Co mission
in an area of environmental concern pursuant to 15 NCAC Subchapter 7K , (9-B)319-5
>licant Name o+P-&,Kwakov*o&Phone Number
Iress
St to Zip
ject Lo tion (County, St a e. Road, Water Bod , etc.) i
.} �tS-e-u✓►4 11\ly �n) 0C--T o % l in lTI..
e and Dimensions of Project
)roposed project to be located and constructed as described
is hereby certified as exempt froin the CAMA permit
rement pursuant to 15 NCAC 7K , % . This exemption
kMA permit requirements does not alleviate the necessity of
obtaining other State, Federal or Local authorization.
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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2015 11:50PM HP Fax page 2
No
rth Carolina Department of Envkwment and Natural Resourm
&mIy Eaves Pere DWOn of Coatial Management
WOW James H. Orepm Dee Free
DaM Seca
AGENT At,)Tf I� TION FORM
gate: .ZI21 3 A57
Name of Property Owner Applying for Permit: Name of Agent tar this project:
Owner's Malff'ng Address:
Phone Number (Fq3 So 5-0
Agent's Aearfing Addresa:
9 t
Phone Number(
I certify that 1 have authorized the agent Wed above to act on my behalf, for the purpose of sppfying
fot and obteirfg aN CAMA Permits necessary to instal or construct the following (activity):
A l
(MY prowY located) at
This certification is volt! thru (date)
Property Owns igrWare pate
RECEIVED
DCM WILMINGTON, N(
FFR 2 4 2015

4 2015 11:50PM HP Fax page 1
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