Sikes

icant Name
CERTIFICATION OF EXEMPTION
FROM REQUIRING A CAMA PERMIT
as authorized by the State of North Carolina,
Department of Environment, Health, and Natural Resources and the Coastal Resources Commission
in an area of environmental concern pursuant to 15 NCAC Subchapter 71KL
lL-s_ o �i �t�<��r�Sb� PhoneNumber1163(0* U3`.
and Dimensions of Project
)roposed project to be located and constructed as described
e is hereby certified as exempt from the CAMA permit re-
ment pursuant to 15 NCAC 7K .0 This exemption to
A permit requirements does not atr e the necessity of
obtaining any other State, Federal, or Local authorization.
This certification of exemption from requiring a CAMA pei
valid for 90 days from the date of issuance. Following expir
a re-examination of the project and project site may be necE
to continue this certification.
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FROM :RICHPFL)SON CONSTRUCTION FRX NO. :9108425597 May. 23 2012 08:58W P)
i
CERTIFI ATION OF EXEMPTION
Y
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FROM REQUI G A LAMA PERMIT {
by theyt a Nona Lend Not
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CO fM onl• Neahh, and Nalurd itosoaraos orrt the Cne31a1 Rssouloae Gomm!suion
..r^^ ni •rre�om puBunnt to IB NCAC BubtlmDtor 7K,�7Ee,sy _4AC
via tr,�
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Type, and Ulntane,l u Of YrcWcl _ l.ld/JlAiii.i ••� --.
Thopropoe,adproladt0biboaladA^d0onot asdondvxrbod ThMWill(IDatkndosompdon%vmtoWi". aCAMApormtIt
above Is hereby aon'IWd aA exempt born the LAMA pormil to- vadW dQ d e Inxn !ho dale of ioausnco. Folowlnp orphaiion.
gt.:lramoht osirsuom to 15 NCAC7f%
"otnown w o v-wAx d the pion and prg(oot olio may be nacgastlry
LAMA permh rarp�harnunts does not'e nacaswtr Of to Centime this ranpkatbl.
your obtaining any Other State, Federa31 mm (SCAS E;
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Any parson who pt000ads vutih a do+rotopRion! wkhovt t ro con•
oar, of a CAMA otik2al underths mlolakarj aaaump'bn Ihsf the
de.slopmsmissxsmptod.V416010)vloict"a, olihoCAUAlllharo
is o aubea4uent dalerminatlon the; 0 gam w:s requLed lot the
ya demMoni. I
Tro appiloard oanCtoa by signF thb as �pllon that (t 1 the w
..a..m tin. -nd end wIA ablds by the Mons 01 tints eKamp-
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PR
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue James H. Gregson
Governor Director
Dee Freemar
Secretary
AGENT AUTHORIZATION FORM
Date:
Name of Property Owner Applying for Permit: IName of Authorized Agent for this project:
k
Owner's Mailing Address:
/AAIL, fl; S ]R,, rash, ter?
I I�r-,,► n1 U a g! 3
Phone Number Mt4 6 c , a7 S�3
Agent's Mailing Address:
3, 3s C41
1 ^ Y G
Phone Number 7-T2--�t,`�
I certify that 1 have authorized the agent listed above to act on my behalf, for the purpose of applying
for and obtaining all CAMA Permitsnecessary
r
necessary to install or construct the following (activity):
k e� . r i n c- �,'�Q C• r)e ,1� 1 Li nS Ma, -.-A I-& I S
(my property located) at
This certification is valid thru (date) JS - / •- /c )-
1.
Property Owner Signature Date