02201D - O'Shields

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licant Name
CERTIFICATE OF EXEMPTION
FROM REQUIRING A CAMA PERMIT M
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as authorized by the State of North Carolina, v
Department of Environment and Natural Resources and the Coastal Resources Commission
in an area of environmental concern pursuant to 15 NCAC Subchapter 7K i i, �:, , 1qq I L 5=1-9 Cl Cc
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>roposed project to be located and constructed as described
is hereby certified as exempt from the CAMA permit
rement pursuant to 15 NCAC 7K (`I ( 2 . This exemption
kMA permit requirements does not alleviate the necessity of
obtaining other State, Federal or Local authorization.
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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North Carolina Department of Environment and Natural Resources
Division of Coastal Management
leverly Eaves Perdue James H. Gregson
.3overnor Director
AGENT AUTHORIZATION FORM
Date: 05. 0y.(3
Dee Freeman
Secretary
ame of Property Oyvnef Applying for Permit: me of Authorized Agent for this project:
wner's Math g Address: Agent's Mailing Address:
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certify that I have authorized the agent listed above to act on my behalf, for the purpose of applying
)r and obtaining all CAMA Permits necessary to install or construct the following (activity):
my property located) at nV�e S
rhis cerldicatictKivalid thru (date)
Property Owner Signature
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Date
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