02220D - West

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CERTIFICATE OF EXEMPTION
FROM REQUIRING A LAMA PERMIT 02
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 • bj 46 .
plicant NprneWN6G UVA 0 AUJtd I �G i1IU k+l Phone Number
,dress 0.
y State Zip
Dject Location (Country, State Road, Water Body, etc.) 9
pe and Dimensions of Project
proposed project to be located and constructed as described
ve is hereby certified as exempt from the CAMA permit
drement pursuant to 15 NCAC 7K , ()I 0,�) . This exemption
:AMA permit requirements does not alleviate the necessity of
r obtaining other State, Federal or Local authorization.
This certification of exemption from requiring a CAMA
valid for 99 days from the date of issuance. Following ex
a re-examination of the project and project site may be r
to continue this certification.
KETCH (SCALE:
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N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date j a0 I d
Name of Property Owner Applying for Permit:
Mailing Address:
I certify that I have authorized (agent) &eJ / ao(rye 6441S_ UGto act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity)
at (my property located at) (rm" Ll P1 e-(
This certification is valid thru (date)
01
Prnnerty owner Siunature
"
Date

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"'or"-/ 501:41
RECEIVED
DCM WILMINGTON, NC
MAY 22LuI