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plicant Name
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ject Loca 'on
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CERTIFICATE OF EXEMPTION 'q
FROM REQUIRING A LAMA PERMIT ''9' t 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 .. Q IC ?47--
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�(11��k►, Q=JIj% j(J— (Jo Phone Number "/��L J�-4 tK;�
(County, State Road, Water Body,
rciA1- Jai 4ll 1 A
and Dimensions of Project
E proposed project to be located and constructed as described
,ve is hereby certified as exempt fro e CAMA permit
uirement pursuant to 15 NCAC 7K ,117F�. This exemption
:AMA permit requirements does not alleviate the necessity of
r obtaining other State, Federal or Local authorization.
This certification of exemption from requiring a CAMA
valid for 90 daj. from the date of issuance. Following e)
a re-examination of the project and project site may be i
to continue this certification.
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Aug. 25. 20144 3: 44PK FA,t 1 an t I' c I n t e r n a 1 �(910)154 11401e 9108925597 No, 6632 P. _lacE.
WDE NK
North Carolina Department of Environment and Natural Resources
Division of Coastal Managemeht
Gevarly Eaves Perdue James H. GregSAn gee Freeman
Governor Diractor seorelary
AGENT AUTHORIZATION FORM
Date," l
lame of Property Owner Applying for Permit: Name of Authorized Agent for this project:
m --G � t `e��fCl cij'4
hvner's Malling Address:
'hone N.r nber D0 } I�§2 -- S,07-9
Agent's Mailing Address:
Phone Number'/ E 7--6&R_C_
cWtily that I have authorized the ago:il list0 above to act on my behalf, for the purpose of applying
x and obtaining all LAMA permits necessary to instill or construct the following (acl;vity):
Eli e,
ny property located) a; Q
'his certifcat, li (date)
I
Property Owner signature Date

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