01707D - Price

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CERTIFICATE OF EXEMPTION ��y$
FROM REQUIRING A LAMA PERMIT 011
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 to15(,NCAC Subchapter 7K. L. lk -S1
licantNameJ\Lbtf4 4 . �Y�Ce C��C i� (C t TlY�it H L� Phone Number (0215C{ 1S
ect Lobation (gounty, State Rpad, Water Body, etc.) U(W`11�
e and Dimensions of Project
)roposed project to be located and constructed as described
is hereby certified as exempt from the CAMA permit
-ement pursuant to 15 NCAC 7K N 17 . This exemption
AMA 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.
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Applicant
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City
CERTIFICATE OF EXEMPTION
FROM REQUIRING A CAMA PERMIT
0 1'
as authorised by the State of North Carolina,
Department of Envirournent and Natural Resources and the Coastal Resourcebt)Ttsslon
n an area of environmental concern pursuint to 15 NCAC Subchapter 1K
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inty, State Zip Water F�ody, etc.)
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Type and Di kensions of Project
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The proposed project to be located and constructed as described
above is hereby certified at exempt f CAMA permit
pursuant pursuant to 15 NCAC, 7K :Upermit. This exemption
to CAMA permit requirements does not alleviate the necessity of
"r obtaining other State, Federal of Local authorization,
This certification of exemption from requiring a CAMA p
valid for 90 days from the date of issuance. Following exp
a re-exarnination of the project and project site may be ne
to cositinue this certificirlon.
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North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue James H. GreWn
Governor Director
Dee Freei
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AGENT AUTHORIZATION FORM
Date: INN
Nar;ipe of Properxy C7wner Applying for Permit Name of Authorized Agent for this project
Owner's Malting, Address,
Ii/0 1,3tj,�Iwpl
Agent's Mailing Address:
Phone Number _/�-1 7 Phone Number AL L 7-2
I certify that I have authorized the agent listed above to act on my behalf, for the purpose of applying
for and obtaining all LAMA Permits necessary to install or construct the following (activity):
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(my property located) at 1412 14-�( A�E� t)�Z I f
This certg' tic is valid t (date).
FIF—GE1V ED
Prop Owner Signature Date DCM \NILMINUTON, NC
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RECEIVED
DCM WILMINGTON, NC
i A N 13 ',n,4