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CERTIFICATE OF EXEMPTION
FROM REQUIRING A LAMA PERMIT
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 .
4icant
e and Dimensions of Project
)roposed project to be located and constructed as described
e is hereby certified as exempt from the CAMA permit
rement pursuant to 15 NCAC 7K.hl('�` . This exemption
kMA permit requirements does not alleviate the necessity of
obtaining other State, Federal or Local authorization.
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This certification of exemption from requiring a CAMA pi
valid for 90 days from the date of issuance. Following exp
a re-exar6 t n of the project and project site may be ne
to continue this certification.
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CERTIFICATE OF EXEMPTION
FROM REQUIRING A CAMA PERMIT N° 021210,
as authorized by the State of North Carolina,
Department of Environment and Natural Resources and the Coastal Resources CommUon
in an area of environmental concern pursuant to 15 NCAC Subchapter 7Kke,
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Type and Dimensions of Project
The proposed protect to be located and constructed as described
above is hereby certified as exempt from the CAMA permit
nequimmentpursuantto 15 NCAC TK an _ This exemption
to LAMA permit requirements does not alleviate the necessity of
your obtaining other State, Federal or Local authorization.
WE
This certification of exemption from requiring a CAMA permit is
valid for �90 from the the date of issuance. Following expiation,
a re-exa-mtnation of the project and project site may be necessary
to continue this certification.
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Any person who proceeds with a development without the con-
sent of a CAMA official under the mistaken assumption that the
development is exempted, will be inviolation of the CAMArf there
is a subsequent determination that a permit was required for the
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N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date
Name of Property Owner Applying for Permit:
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Mailing Address:
I certify that I have authorized (agent) ff/// /;4,,W4 S' to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity) Ile ;k,/
at (my property located at)
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IMis certification is valid thru (date)
Property Owner Signature / Date

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