01609D - Szatko

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CERTIFICATE OF EXEMPTION
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
L)
State Road, Water Body, etc.)
and Dimensions of Project
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proposed project to be located and constructed as described
e is hereby certified as exempt from the CAMA permit
iirement pursuant to 15 NCAC 7K N C ':k . This exemption
:AMA permit requirements does not alleviate the necessity of
- obtaining other State, Federal or Local authorization.
01
Phone Numbe(31!��-3
Zip 1
This certification of exemption from requiring a CAMA I
valid for 90 days from the date of issuance. Following ex
a re-examination of the project and project site may be n
to continue this certification.
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North Carolina Department of Environment and Natural Resources
Division of Coastal Management
McCrory Braxton C. Davis John E. Skvarla,
vemor Director Secretary
AGENT AUTHORIZATION FORM AGENT AUTHORIZATION FuRm
Date: �G oho%5�-
ie of Property Owner Applying for Permit:
Leoey,3 Sze
ier's Mailing Address:
me Number (3/S) 7,23 5 6
ame of Authorized Agent for this project:
Agent's Mailing Address:
Ss��ych [��L
Phone Number�klb) \S-7cJ-9095
rtify that I have authorized the agent listed above to act on my behalf, for the purpose of applying
obtaining all CAMA Permits necessary to install or construct the following (activity):
my property located at i'vk --.)?i
s certification is valid thru (date)
Property Ov6Wer Signature
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Date
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