Brown (3)

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11�CERTIFICATION OF EXEMPTION
FROM REQUIRING A CAMA PERMIT
as authorized by the State of North Carolina,
k '= Department of Environment, Health, and Natural Resources and the Coastal Resources Commission
in an area of environmental concern pursuant to 15 NCAC Subchapter 7K .0203.
cant Name 'kPA+ p!(0W" `/G C/�AA2IPs /'�a Pe � Phone Number ?/U .3F6•��
ess /� 7 /��� A PIC,N 4 .ST.
ict
and Dimensions of Project )YCw t, e-coo's v ..PPi9�iw Ze, 2 W /,r ,,
roposed project to be located and constructed as described
is hereby certified as exempt from the CAMA permit re-
pent pursuant to 15 NCAC 7K .0203. This exemption to
% permit requirements does not alleviate the necessity of
)btaining any other State, Federal, or Local authorization.
This certification of exemption from requiring a CAMA per
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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PIA
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
everly Eaves Perdue James H. Gregson Dee Freerr
'overnor Director Secret
AGENT AUTHORIZATION FORM
Date'. 3
1-04-Zt—
ame of Property Owner Applying for Permit: Name f Auth rized Agent for this project:
64- 0Q A
wner's Mailing Address'.
hone Number L??4
Agent's Mailing Address:
_D D
S
Phone Number 9�a
certify that I have authorized the agent listed above to act on my behalf, for the purpose of applying
or and obtaining all CAMA Permits necessary to install or construct the following (activity):
re. JL//__.11 ✓n ,, r (/,, f
;my property located) at
This certification is valid thru (date)
l
Property Owner Signature Da

Existing Dock
PIL
105 HlghPoint
of
New
Canal
2111111
Existing Dock
Area
107 HlghPolnl