Addante

CERTIFICATION OF EXEMPTION
FROM REQUIRING A CAMA PERMIT
as authorized by the State of North Carolina,
k 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 19 1,& e t�d Phone Number 7.0
ass " ga ad,r
State Zip --? g
ct Location (county, State Road, Water Body, etc.)
�7 7' aq Pam.✓
and Dimensions of Project��,�/7
roposed project to be located and constructed as described This certification of exemption from requiring a CAMA pert
is hereby certified as exempt from the CAMA permit re- valid for 90 days from the date of issuance. Following expir<
nent pursuant to 15 NCAC 7K .0203. This exemption to a re-examination of the project and project site may be nece�
\ permit requirements does not alleviate the necessity of to continue this certification.
ibtaining any other State, Federal, or Local authorization.
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.10A812010 FRI 1;24 FAX 910842H482
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NCB NR
North Carolina Department of Environment and Natural Resources
Division of Coastai Management
Jades H. Gregson
Director
Beverly Eaves Perdue
Gmemor
Dee Freeman
secretary
gGF-Vr AUTHORIZATION FORM
Date:
j (-,
Name of Property Owner Applying for Permit: NaLL
e of Authorized Agent for this �rojeet:
Y 9
IV) f. e
Owrer's Maifing P.ddress:
Phone Number `2
Agent's Mailing Address: , +t
r
Phone Number(, j())
I certify that I have authorized fhe agent listed above to act on my beNRlf, for th9 purpose of apprying
for and obtaining all LAMA Permits necessary to install or construct the follovring (activity):
(my p`oPei;y i,)csted) at
This certiiication is valid thru (date)
Property Owner Signature
r"
Date
RECEiVEv
DCM WILMINGTON, NC
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