02268D - Stallings

CERTIFICATE OF EXEMPTION
FROM REQUIRING A CAMA 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 i v )! I, 7;�I, (;
flicant Name
Iress 1_1'L.
e and uimensions of Project
proposed project to be located and constructed as described
e is hereby certified as exempt from e CAMA permit
rement pursuant to 15 NCAC 7K . I. ; li . 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 p
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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NCDEENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Pat McCrory Braxton C. Davis John E. Ski
Governor Director Secre
AGENT AUTHORIZATION FORM
Date:
Name of Property Owner Applying for Permit.- Na e�of prized Agent for this project:
Owner's INaffng Address:
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Phone Number( �d 9 9G yGi
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Phone
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):
4L-�c Ate
For my property located at
This certifi ti is valid thru (date)
Owner ro

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