01721D - Courie

licant Name
ress _►`b 1
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 Commission
in an area of environmental concern pursuant to 15 NCAC Subchapter 7K ti I }4 e,4
VI( ��L`1l ✓�t goAin, dj-e-, Phone Number 1U4a.w
ject Location (County, State Road, Water Body, etc.)
A (.t l I-{ V 41 li vJ I. i f t o
e and Dimensions of Project
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
r obtaining other State, Federal or Local authorization.
State
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This certification of exemption from requiring a CAMA
valid for 90 days from the date of issuance. Following ex
a re-examination of the project and project site may be r
to continue this certification.
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CER7FIFICA�TE CIF EXEMPTION
-- w r R, O'M REC�UIRiNb A LAMA ERMI N° 01'73
u authotiml by che'state of North Catalina,
I� a r�rs� nt of t nvlrtNtttietit atici,N.�urral ]tesourccs and the Coastal Resources Commission
eitvlFonntental concern pursuant to IS IINCAC Subchapter
Cu,.(. hone Number l4 '
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At{t�r s , 1 0 047,C IP r estate N P. �..$,�s
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F'rtr ect L.cji; tion (C,c,unty;;'t�ta ttoad, Water t3oc1
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Type and Cimcnsions i;l PW t--d . 1�i���i �� , OIYt� �t GkQ-�
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I he pKiject to be locited anJ toastcuctesi as.dr�ctit�tt Ihi� terdfication of exemption from tequiring a LAMA pemtit E
at;u:re is hmby cettitie�l ;ts,eu mpt. frorti .the CNMA permit valid for 9, 0 days froth cite date of issuance: following extairatton
tectuiretnkncpuuuaiftta 15 N(-AC 7Y, .0 03- This exetnptigi' a ce-exlminatiott of the protect and protect site ntay. be Etecessar
tc.� CI�NA pc�rttt r�:ciulrentents tom, not alleviate the necess(ty of:,to continue this cettsficatton. .
you olitaitling Utiv.r State, Fectetnl or LocialatltUrfittion.
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North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Pat iUcCrory Braxton C. Davis John E. Skvada, III
Director Secretary
Governor
AGENT AUTHORIZATIONS RM
Date: 1�
Name of property Owner Applying for Permit: Name of Authorized Agent for this project:
AiaN Hotde�
Owner's Malting Address:
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Email. vlce AhyD •Lov^"
Phone (Ti 4] N9,G g tP 9� 1 •�
Agent's Mailing Address;
Email: M61 rv�ew�4n1�� fit-14��10 vacr.'�zoy!
Phone 0 {u ) 'o9 29 5`� ►f S _--
I certify that I have authorized the agent listed above to act on my behalf, for the purpose of applying
for. and obtaining all CAMA Permits necessary to install or construct the following (activity):
VJ& WA"i<way -�.
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For my property located at 1 y'I'14-T
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This certification is valid t year from (date) y12t �!
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4p rty Owner Signature Date

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