Casey

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 7K .0203.
icant Name In �0 60 P Phone Number%7Y %—G
-ess wC&rl ,
v c State S Zip
;ct Location (County, State Road, Water Body, etc.) A ,19c r 41
and Dimensions of Project / N A I v pA p.,. P ti
)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 .0203. This exemption to
A permit requirements does not alleviate the necessity of
obtaining any other State, Federal, or Local authorization.
This certification of exemption from requiring a CAMA pet
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.
=TCH (SCALE: / �rJ

3
I

AGENT AUTHORIZATION FORM
Date:
Vame of Property. Owner Applying for Permit:
Wailing Address:
?hone Number: S
certify that I have authorized (agent) -kom &Open _ to act on my
)ehalf, for the purpose of applying for and obtaining all CAMA Permits necessary to install or
.onstruct (activity) _re`,pjklC's 0 e415+1 nla
It (my property located at)
"his certification is valid thru (date)
S.
rty Owner Signature
laj—,,L .Ao/,/
Data
127 Cardinal Drive Ext., W46ri9ton, NC 28405
Phone, 910-796.72151 FAX: 91M993964 Internet: www.nccowairnwag"ent.net N O C ��
yaro na
E94I OyDQ �Y l AMrmaAvp Atlbn Employer t An�f�/