McDonald

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.
licant Name IA 111 /fins /T� ` _��1�� �� �� -� �� 7'/`oMA1 Phone Number 70 �' 4 `
ress % 2 e- C ;,
h -f State zip 2 a
act Location (County, State Road,Water Body, etc.) 2- N S i
a - ,Ad'e r� f /,� -{ g �. , ,,, Z'i G e 4 4T_ oN f W�<�� C dui
and Dimensions of Project Ik e c / e19
Droposed 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
IA permit requirements does not alleviate the necessity of
obtaining any other State, Federal, or Local authorization.
This certification of exemption from requiring a CAMA pe
valid for 90 days from the date of issuance. Following expi
a re-examination of the project and project site may be nec(
to continue this certification.
ETCH (SCALE:
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North Carofina Department of Erlvironnnent, and (`Natural Resources
Division of Coastat tAanagement
Beverly Eaves Perdue ,lames .H. Cregson Dee Freeman
"Overnor 1, ectc- Secretary
AGENT AUTHOR;ZATIOA! FOR
Date: _ I���) IL/ -
Name of Property Owner Applying for Permit: Name of Authorized Agent for This proiect:
Owner's Malting Address:
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Phone Number (2*1 Jba— �ofJ S
Agenfs Maifing Address: j
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t=none Number tgg 1 4 yam_ 3 6) -5—
i certify that I have authorized the agent listed above to act an my behalf, for" purpose of appiyir.Y
for and obtaining all LAMA Permits necessary to Install or construct the following (activity):
(mv orooerty iocatedP at �a 4: ' u
This certification is valid fhru (dais) .- -;��
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P!Onefty owner'siar?ature Dais

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