HomeMy WebLinkAboutSneadsCERTIFICATION OF EXEMPTION
FROM REQUIRING A CAMA PERMIT
as authorized by the State of North Carolina,
Department of Environment, Health, and Natural Resources and the Coastal Resources Commission
in an area of environmental concern pursuant to 1P NPAC Subchapter 7K .0203.
ilicant Name Y , �JiY ' Phone Number
ress %'� I IL 0 . VC iAG v I YA YV
ect Location (County, State Road, Water
t. A .. ., L �..... I .. n 1 1. _ e
e and Dimiensions of Project
proposed project to be located and constructed as described
ie is hereby certified as exempt from the CAMA permit re-
�ment pursuant to 15 NCAC 7K .0203. This exemption to
1A permit requirements does not alleviate the necessity of
obtaining any 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 nec
to continue this certification.
;ETCH (SCALE:
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NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue James H. Gregson Dee Freerr
Governor Director Secret.
AGENT AUTHORIZATION FORM
Date: 2 2 1 // Y
lame of Property Owner Applying for Permit: Name of Authorized Agent for this project:
V,�J
JFjO'1 / ,91 lU4
)wner's Mailing Address:
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'hone Number(11, ) sau - s zt F
Agent's Mailing Address:
Phone Number (I")
I certify that I have authorized the agent listed above to act on my behalf, for the purpose of applying
for and obtaining all CAMA Permits necessary to install or construct the following (activity):
(my property located) at 3 4 ,- —
This certification is valid thru (date)
/�W & / 2 / i / // LI
Property Owner Signature Date
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