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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 .02,a3:
.0163
plicant Name Phone Number 263% l
dress
y State NC Zip -Z�
)ject L cation (County, State Road, Water Body, etc.)
)e and Dimensions of Pf oject
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a proposed project to be located and constructed as described
we is hereby certified as exempt from the CAMA permit re-
'ement pursuant to 15 NCAC 7K .0203. This exemption to
MA permit requirements does not alleviate the necessity of
it obtaining any other State, Federal, or Local authorization.
This certification of exemption from requiring a CAMA p
valid for 90 days from the date of issuance. Following exl
a re-examin� a ii on of the project and project site may be ne
to continue this certification.
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*I F. Easiey, Govemor
A
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
James H. Gregson, Director
Authorized Agent Consent Agreement
W14tam G. Ross
�x is hereby authorized to act on mi.
(Printed Name of Atf MY "
er to obtain any CAMA permit(s) required for the property fisted below. The authorization is limi
is activities described in the attached sketch.
ITION OF PROJECT.
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PERTY OWNER MAILING ADDRESS:
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16�9 ` k2V--3 C> 11,4 e P42A n
drRt'CSCIRQ PHONE NO.��� 2�'7• d��j�
10RIZED AGENT MAILING ADDRESS:
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PHONE N0. 9/0���� �y��

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