01774D - Foust

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ilicant Name
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CERTIFICATE OF EXEMPTION �r ��' 1
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_,
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e and uimensions of rrolect
)roposed project to be located and constructed as described This certification of exemption from requiring a CAMA p�
is hereby certified as exempt fr m the CAMA permit valid for 90 days from the date of issuance. Following exp
rement pursuant to 15 NCAC 7K r,���;°� . This exemption a re-examination of the project and project site may be ne
kMA permit requirements does not alleviate the necessity of to continue this certification.
obtaining other State, Federal or Local authorization.
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John W Foust M.D.
7043643327 p.1
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NCDETIR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
at McCrory Braxton C. Davis John E. Skvarla,
Governor Director Secretary
AGENT AUTHORIZATION FORM AGENT AUTHORIZATION FUKM
Date: l
ime of Property Owner Applying for Permit: Name of Authorized Agent for this project:
vner's Mailing Address:
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one Number
Agent's Mailing Address:
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Phone Number &, D) 57 kq5r
ertify that I have authorized the agent listed above to act on my behalf, for the purpose of applying
and obtaining all CAMA Permits necessary to install or construct the following (activity):
,r my property located at
is certification is valid thru (date)
"D / L
P ' perty Owner Signature Date

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