02221D - Rash

CERTIFICATE OF EXEMPTION
FROM REQUIRING A LAMA PERMIT 02t'
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 . C3
licant fame �Q�h 1iCl�,Sh ItjlYlsfirz ( F► C��(--I VAc. Phone Number qto SIct "A iS
ject LocatioW(County, State Road, Water Body, etc.)
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e and Dimensions of Project
)roposed project to be located and constructed as described
is hereby certified as exempt fr, Oe CAMA permit
rement pursuant to 15 NCAC 7K U rt .i . This exemption
kMA permit requirements does not alleviate the necessity of
obtaining other State, Federal or Local authorization.
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This certification of exemption from requiring a CAMA pi
valid for 90 days from the date of issuance. Following exp
a re-examination of the project and project site may be ne
to continue this certification.
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NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Pat McCrory Braxton C. Davis John E.
Governor Director Se
AGENT AUTHORIZATION FORM AGENT AUTHORIZATION FUHM
Date:
Name of Property Owner Applying for Permit: Name of Authorized Agent for this projec
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Owner's Mailing Address:
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Agent's Mailing Address:
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Phone Number 03j-1 Z(c iC—,.- � Phone Number q&� 5-7 q -q jy �;--
I certify that I have authorized the agent listed above to act on my behalf, for the purpose of applyir
for and obtaining all CAMA Permits necessary to install or construct the following (activity):
For my property located at
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