02113D - Donahue

CERTIFICATE OF EXEMPTION MG
FROM REQUIRING A LAMA PERMIT 021
as authorized by the State of North Carolina,
Department of Environment and Natural Resources and the Coastal Resources C mission
in an area of environmental concern pursuant to 15 NCAC Subchapter 7K
Acant Name �' u 0.h �o� �� Phone Number/ �Iu 43-9 8
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jectkoec ' n (Count , State Road, Water ody, etc.) 1 Sir ( va G{C
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proposed project to be located and constructed as described This certification of exemption from requiringCAMA
a p
e is hereby certified as exempt from jhe CAMA permit valid for 90 days from the date of issuance. Following exF
rement pursuant to 15 NCAC 7K t; I � . This exemption a re-examination of the project and project site may be n(
4MA permit requirements does not alleviate the necessity of to continue this certification.
obtaining other State, Federal or Local authorization.
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North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue James H. Gregson
Governor Director
AGENT AUTHORIZATION FORM
)ate: ) 3
Jame of Property Owner Applying for Permit:
TSeo n, .
failing Address:
Anderson Dtz.
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(hone Number: 03 .2.1
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certify that I have authorized (agent) KPia COOKE to act on my
)ehatf, for the purpose of applying for and obtaining all CAMA Permits necessary to install or
:onstruct (activity)
it (my property loc
Phis certification is valid thru (date) 3
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