Hyman

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.
cant Name
ass "hb1(
and Dimensions of Project
roposed project to be located and constructed as described
a is hereby certified as exempt from the CAMA permit re-
nent pursuant to 15 NCAC 7K .Ogp�. This exemption to
a permit requirements does not AeViAe the necessity of
)btaining any other State, Federal, or Local authorization.
Phone Number, q14) 7- jZL
This certification of exemption from requiring a CAMA per
valid for 90 days from the date of issuance. Following expin
a re-examination of the project and project site may be nece
to continue this certification.
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NC'DENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Gael F. Eawy, Governor James H. Gregson, Director wWam G. Ros
Authorized Agent Consent Agreement
is hereby authorized to act on m
(rnnrsa rams of Awn
ler to obtain any CAMA permit(s) required for the property listed below. The authorization is lim
fic activities described in the attached sketch
knON OF PROJECT:
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DERTY OWNER MAILING ADDRESS:
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Ci _ PHONE NO.
4ORIZED AGENT MAILING ADDRESS:
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PHONE NO. P 3�
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