01785D - Bodenhamer

CERTIFICATE OF EXEMPTION V �`' ve\
FROM REQUIRING A LAMA PERMIT 01 i
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 71<� , 1' w 3
"
licant Name 0 L Y1U U S shone Number, "S qG`
ress
State
ct Location County, St to Ro , Water Bod , etc.) 05lJ -e
Ia ae IVA
e and Dimensions of Project
Q 1/ twoitxX -f 6 c F, t x1
a I L1o, W A o -u d
)roposed project to be located and constructed as described
is hereby certified as exempt from the CAMA permit
rement pursuant to 15 NCAC 7K (J 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 pE
valid for 90 days from the date of issuance. Following expi
a re-examination of the project and project site may be ne
to continue this certification.
ETCH (SCALE:
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fir—iVA .•�
OC&DEHR Natural Resources
North Carolina Department of Environment and Nat
Division of Coastal Management Dee Free
n
Beverly Eaves Perdue James H. Gregson SecDirector
Governor
AGENT AUTHORIZATION FORM
Date:�G
for Permit: Nine of Authorized Agent for this project:
Name of Property Owner Applying Q3�Y15�Cuc� 6 o
�9 y! al ,�ag�c w J� rr► c R
Owner's Mailing Address:
Phone Number Number "7
Agent's Mailing Address:
Sal
z� y
Phone NumberAij�!
q - ql ,,
ur ose of applying
struct the following ( I certify that I have authorized the agent listed above to act on my behalf, for the purpose
for and obtaining all CAMA Permits necessary to install or con(activity):
(my property located) at
This'certification is valid thru (date)
LOA
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