01757D - Price

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licant N e
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ect Location
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 , i �, , . �, { ) 6 w -u e
IA�IMIZ 01 Ldcc qo VCC i K_C Phone Number
, State Road, Water Body, etc.)
e and Dimensions of Project
M
)roposed project to be located and constructed as described
is hereby certified as exempt from the CAMA permit
rement pursuant to 15 NCAC 7K . (, I 1. This exemption
\MA permit requirements does not alleviate the necessity of
obtaining other State, Federal or Local authorization.
State
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.
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CERTIFICATE OF EXEMPTION
FROM REQUIRING A CAMA PERMIT N° 0175M
as authorhed by the State of North Carolina,
Department of Environment and Natural Resources and ilia Coastal Resource s missl n
In an area of environmental concern pursuant to I S NCAC Subchapter 7K. , Clrraa(��o) W1
Applicant N o Y_�� ,1 it .__ Phone NumberCjiU 5 a Q -
Addre _. _ ZY11S1 —
�� __
City ---_-- Stale _ ___ ZI •L'-
Pro ect Location ( ounty, State Road, WeiQr Body, etc)Wj41i _
Typo and Dimensions of Projecl _
The proposed project to be located and constructed as described This certification of exemption from requiring a LAMA pemdt Is
above Is hereby certified as exempt front t a CAMA penult valid for 90 days from the date of Issuance. Following expiration,
requirement pursuant to IS NCAC 7K �QP . This exemption a re•exattsinagon of the project and project site may be necessary
to CAMA penult requirements does not alleviate the necessity of to continue this certification.
your obtaining other State, Federal or Local authorization.
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Any person who proceeds with o development without ilia con-
sent of a CAMA official under the mistaken assumption that the
development is exempted, will be In violation of the CAMA If there
Ise s05oquoat determination that a permit was required for the
development.
F-- --I he applicant cantles, by stoning this oxemption that it) the ap- ------
pl.cant has road and will abide by ilia conditions of this oxomp-
tion, and (2), hteastateawat vesboertobtahnal l— rrdMeon,
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Altachnunt: IS Norih Cnrolina Adndnistrnlive Coda 7K

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NCDENR
North Carolina Department of Environment and
Division of Coastal Management
McCrory Braxton C. Davis
ovemor Director
Natural Resources
John E. Skvarta,
Secretary
AGENT AUTHORIZATION FORM
Date:
ie of Property Owner Applying for Permit: Name of Authorized ;Agent for this project:
Jri.?2 !> // �,>Lle--- Y',�lL_ --L IlL. i�iC<f1.✓ /v%,zic
ier's Mailing Address:
-J (e �/ z,-,7-5-,cWc
�%►,4.z /off /VL oZk2.2'7
ne Number(`/J) ls7`/- iiv3
Agent's Mailing Address:
Jcx)3 I /olds.,
Phone Number ( fO)
lify that I have authorized the agent listed above to act on my behalf, for the purpose of applying
rnd obtaining all CAMA Permits necessary to install or construct the following (activity):
my property located at //.Z 5;1-
certification is valid thru (date) y
roperty Owner Signature Dat

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DECEIVED
DCM WILMINGTON, NC
1,: AY 2 1 2u- 14