01715D - Brown

CERTIFICATE OF EXEMPTION
FROM REQUIRING A LAMA PERMIT
01"
as authorized by the State of North Carolina,
Department of Environment and Natural Resources and the Coastal Resources mmission
in an area of environmental concern pursuant to 15 NCAC Subchapter 7K i) 0 3
N 1.41 P
flicant Name CA,, ba0kW#u4fJV10rJrUb Phone Number I6
cress
State b Zip La
ject Loc tion (County, State Road, Water Body, etc.)
b i
011
le and Dimensions of Project ,
proposed project to be located and constructed as described
e is hereby certified as exempt from the CAMA permit
rement pursuant to 15 NCAC 7K . (0 .This exemption
A,MA 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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10,,2014 09:04 FAX
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CERT[FiCATE OF EXEMPTION
FROM RE(4UIRING A CAMA PERMIT N? 0171
as authorized by dja State of North C.irgitna,
Department of ErMronntont and Natural Resource: And the Coo►stal Resources rn Won
in an rtt_ ,t of dnv"nnvrjral concern pttrsuam to 15 NCAC Subchapter 7K
Phone Number Rl �
mix
c►urn �T.;""�`ie?`i;'�
he Proposed prvfatt to ba incased 00d strutted art described This cerUftotton Vf examption from requirbW a C^HA Viorml
►ova M hereby terdflyd as exempt CAM^ permit valid fir'it) the data of �uaWe. F*Vowbs e;plrad
quiromenr pursunneto 15 NCAC 7K 0 ffrts exetttpUpn a re'v4-mina an or the prof alto project site may be nw A=
CAMA penwdt rienuirements does rux Cq the necessity of to condnue this rerUllcation"
►ur obtaining other State, Federal or Iota audtaritadon.
SKI-.MH ($CALV
rq
,y porcon who prpnooda with a darn
Fnt vt a C?AMA offlCitat undar the mial
►voiopmont to axampted. wNl be In vie
a auboaquant datorminabon that a p
tvulwolant.
is appikuwnt oartilioo by nipning thla
cant has rood and will "Ido by rho
rn, artO
Ila- U W-
pP 7P( Ism
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ant without the con-
naoumptbri that tho n 'o natu
of tho Cr.AMA If thare
woo roqutrod for the
that (t) they ap-
tt this exemp.
Auaohrntnt. 15 North Carollnu Administrative Code 7K
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l5i2014 08:27 FAX
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CCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
'at McCrory Braxton C. Davis John E. Skvarla, III
Governor Director Secretary
AGENT AUTHORIZATION FORM
Date:
41�1-
ame of Property Owner Applying for Permit: Name of Authorized
/Agent for this project:
Nner's Mailing Address:
// 04.
nail:
Agent's Mailing Address:
D
Email: bdCK Q�r
Phone d
:ertify that I have authorized the agent listed above to act on my behalf, for the purpose of applying
r, and obtaining all CAMA Permits necessary to install or construct the following (activity):
>r my property located at
its certification is valid 1 year from (date) ?