01704D - Bressler

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CERTIFICATE OF EXEMPTION 3'
FROM REQUIRING A CAMA 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 ¢!103 .
licant Name
ress
�ject Location (County, State Road, Water Body, etc.)
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Phone Number
State N L
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Zip Z
�e and Dimensions of Project V k�VF %ve-& 7Y +l►��2 /I'L tK1'0 Q-M- fZ EC�NSYI�CT 1 �' x14' �L
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(=. 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 r
to continue this certification.
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N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date D
Name of Property Owner Applying for Permit:
Mailing Address:
llq SF 21"�-
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I certifythat I have authorized (agent) / ���/1 6- ' to at on m (g )Y
behalf, for the purpose of applying r and obtaining all CAMA Permits necessary to
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install or construct (activity) /L1,5 6lt/ �� "�ir ►�
at (my property located at) la 5c 7 h 00j 3 ,4
This certification is valid thru (date) /� /30 IJ 9
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