Stevens

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 71K, 02n.
icant Name
ess SOi
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>roposed project to be located and constructed as described
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 allevi�lteNhe necessity of
Dbtaining 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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/26/2010 01:23 9105-199096 6K1Ct CUN NAUE
North Carolina Department of Environm nt and Natural Resources
Division of Coastal Man ement p� Ffeem
Beverly Eaves Perdue James H. r secret
Governor �"m
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Date:
Vame of Property Owner Applying for Permit
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owner's Mailing Address:
15-6Y Se.nk;►n-S 4.
�EA i If m and N C'
Phone Number /e
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Authorized Agent for this project:
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Ph
I certify that I have authorized the agent listed above to act
for and obtaining all CAMA Permits necessary to install or
a e o#, v se -A- I-) - q
(my property located) at _ ay
This certification is valid thru (date)
;Iw,,r.a-fo►-
Mailing Address'
r l�nCIA-N �1
Number kit . �i "�Oci �-
my behalf, for the purpose of applying
struct the following (activity)'.
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Property Owner Signature Date