02105D - McCain

CERTIFICATE OF EXEMPTION
FROM REQUIRING A CAMA 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 0(63
lica
res
ject Location (County, State
and Dimensions of Project
C. (
Water Body, etc.)
6( Am h VV
proposed project to be located and constructed as described
e is hereby certified as exempt from the CAMA permit
Jirement pursuant to 15 NCAC 7K,,N lb� . This exemption
:AMA permit requirements does not alleviate the necessity of
r obtaining other State, Federal or Local authorization.
Phone Number
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F l ul+( M
This certification of exemption from requiring a CAMA
valid for 90 days from the date of issuance. Following ey
a re-examination of the project and project site may be r
to continue this certification.
KETCH (SCALE:
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NCDENK
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
;hael F. Easley, Governor James H. Gregson, Director William G. Ross Jr
Authorized Agent Consent Agreement
CXI#11 !W is hereby authorized to act cn my bet
(Printed Name of Agent)
rder to obtain any CANIA permit(s) required for the property listed below. The authorization is limited t
cific activities described in the attached sketch.
CATION OF PROJECT:
OPERTY OWNER MAILIN D ESS:
V
-6P— el Ob PHONE NO
JTHORIZED AGENT MAILING ADDRESS:
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Gt/ / UC �br-.Vf 4 f/
PHONE NO.
Ignature of Property Owner:

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