01717D - Brewington

CERTIFICATE OF EXEMPTION
FROM REQUIRING A LAMA PERMIT �11"
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. i , i� .
>licant Name
cress iv'ni'u
I
ject Location (County, State Road, Water
)e and Dimensions of Project I i I
"- )o
proposed project to be located and constructed as described
e is hereby certified as exempt from the CAMA permit
'rementpursuant to 15 NCAC 7K . This exemption
AMA permit requirements does not alleviate the necessity of
obtaining other State, Federal or Local authorization.
-1! C, - 'S:'"— `1 c
Phone Number 9274, 9(yU— L-
This certification of exemption from requiring a CAMA p
valid for 90 days from the date of issuance. Following exf
a re-examination of the project and project site may be ne
to continue this certification.
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41.3/2011. 16:4'j 91057990% GRICE CCC PiAGE 01
CTRTIFICATE OF EXE PTION
FROM REQUIRING A LAMA PERMIT N° 0171
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4 ,1uthonccd by the State of Nor lh Carolina,
Department of Environment and Natural Resources
Ill Mn area of environmenQtal Concern pursua+tt to 15
t pphcm)t ty.vn¢ CS t 1^'G4111'1� ►1 p ,
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I'l-0100 i_ot:,iiion (f;rrunty, ` till.' 1'30cid. Wafer El�u y. C:k.:.) T NM
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f5f ,,-k
I ype end I )irnEnSloir of I1(oject
Vffair -
I iu� tie«{7n<r,',i {)rolcc�. u> hr, ic,rafed :nul concaucted ,u deSCrh>e[!
11)ove h hereby c Ndfied 0 c!xenit?t from the C;AMA petnlit
r'stuhrmentpurs,r.+ntto ;L, N('OAIC 7K Alm. I'hisexemption
o t AMA pt•itim wrllrlion±enrs dox S'•lot ;Fllr•v}ate the nece«ity of
rota obtainint; other Si.ttr f L&I,1l c1 Local aulhc>ruation.
1 the Coastal Resources Commission
CAC Subtlwpte►• 7K.Q3.
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1 U [Aytk._. Phone Nurnber +Q�
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I till cel'tificatlon of exelnptlon from requiring a LAMA perm
Vail for 90 days from the date of Issuance. following expirad
a rr, exarnhration Of the project and project site may be necess
to c ritlnue this cewncation.
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3/,03/2011 18:45 9105799096 GPIC:E CCIH PAGE 02
North Carolina Department of Environrr ent and Natural Resources
Division of Coastal Man igement
iat McCrory Braxton C. Davis
Governor Director
AGENT AUTHORIZATION FORM AGE T AUTHORIZATION FuK
Date: ,_ -` ,) -of //-/
ame of Property Owner Applying for Permit:
E t`C` w
urnor'c llloUlrwn ivirimcc-
S*-
bone Number
John E. Skvarla, It
Secretary
Nami of Authorized Agent for this project:
Agents Mailing Address:
uut_Q�Q_CtQk bZ-5
Phonc Number (L.t( _) 5-7 ` `i u T _
;ertify that I have authorized the agent listed above to act on y behalf, for the purpose of applying
r and obtaining all CAMA Permits necessary to install or can truct the following (activity).
:)r my property located at r - ! __ UCP
his certification is valid thru (date) _
Property Owner Signature Pate

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