01776D - Sunset

Road, Water Body, etc.)
State
�Iicant Name
Tress --Lh
CERTIFICATE OF EXEMPTION
FROM REQUIRING A LAMA PERMIT
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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 ,
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ject Location (Coujlty,
e and Dimensions of Project
iroposed project to be located and constructed as described This certification of exemption from requiring a CAMA pi
is hereby certified as exempt fr he CAMA permit valid for 90 days from the date of issuance. Following exp
rement pursuant to 15 NCAC 7K . This exemption a re-examination of the project and project site may be ne
kMA permit requirements does not alleviate the necessity of to continue this certification.
obtaining other State, Federal or Local authorization.
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Pat NieAr)ry John E. Skv,96
for i : ; r r secretar,
AGENT AUTHORIZATION FORM AGENT AUTHORIZATION FuKm
Date: /4 — Z r 4
lame of Property Owner Applying for Permit: Name of Authorized Agent forthis project:
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'wner's MaHing Address:
200 Soo► s-.c ✓ 6ZA-4 �l
hone Number (Ito ) S"? y - &9Q 9 7
Agent's Mailing Address:
(L/Vi3,-,%a/Jsrdr/
Phone Number (leo ) X'7 f - !2
certify that I have authorized the agent listed above to act on my behalf, for the purpose of applying
it and obtaining all CAM�A Permits necessary to install or construct the following (activity):
e6e goL �alll ej�ale�L. ¢' l/9 S�ci /s�� g` Tn r -e eey, d111 d'eA
A¢ -e �­a o4 P H,7w
or my property located at
its certification is valid thru (date) 62 M,1, 01
Property Owner Signature Date

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