Young

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. ; 4.
licant Name ®Q D c��5 /y1t>�'k"�S�/.n/ �'Lt/t Phone Number T Z
dress Z 1 iC `.
State 42 c Zip 7
ject Location (County, State Road, Water Body, etc.)
V d
e and Dimensions of Project 6t L � ('� /C
[.,/ / 4wi 1_�, i- J" l�) D .-r-
r r ow . / - i
proposed project to be located and constructed as described This certification of exemption from requiring a CAMA K
ve is hereby certified as exempt from the CAMA permit re- valid for 90 days from the date of issuance. Following ex
rement pursuant to 15 NCAC 7K .0203. This exemption to a re-examination of the project and project site may be ne
,MA permit requirements does not alleviate the necessity of to continue this certification.
ar obtaining any other State, Federal, or Local authorization.
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63

1 08:50a STATE FARM JIM YOUNG <-� 3363797385 P.1
Jan•28. 2011 8:36AM ANTE ARNOLE, REALESTr"TE .1 No.3411 P. 1
A�k
NCEWHR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Rev" EavLs Perdue, Guvamor James H. Cregson, Director flee: rreanan, Secrewv
Date
Name of Property Owner Applying for Permit:
Mailing Addrem:
r z'--�ay
I certify that I have authorized (agent) SIC; /, y6,' / � ��,,/,
"'�1 %'`�i �t atc�on my
behalf, f'or the purpose nrappiying for and obtaining all CAMA Permits necessary to
install or construct (activity)
at (toy property located at)
This certification is valid thru (date)
i-ag�aor�
aQ
Owner Signature I / Date

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