Allman

CERTIFICATION OF EXEMPTION
_Y 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.
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cant Name — f a. f? D l •� O ` G�� Phone Number 9 F-.j -3
.SS 3 /3 0� {
�� State C Zip 22_
c anon (County, State Road, Water Bq�l etc.) 11 M
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and Di men ions of Project f o/►�e� ���� ' - �'9 A0 �0'V Z
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,roposed project to be located and constructed as described This certification of exemption from requiring a LAMA per
is hereby certified as exempt from the CAMA permit re- valid for 90 days from the date of issuance. Following expir
ment pursuant to 15 NCAC 7K .0203. This exemption to a re-examination of the project and project site may be nece
A permit requirements does not alleviate the necessity of to continue this certification.
obtaining any other State, Federal, or Local authorization.
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North Carolina Department of Environment and Natural Resources
Division of Coastal Management
3evedy Eaves Perdue .lames H. Gregson
3ovemor Director
AGENT AUTHORIZATION FORM
ate: /""2g/a
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ime of Property Owner Applying for Permit:
n" A//h .4 At
Wing Address:
IL/3
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lone Number.
ertify that I have authorized (agent) _x j ! Z 7�c2 rhC- -f to act on my
half, for the purpose of applying for and obtaining all CAMA Permits necessary to install or
nstruct (activity)
(my property loc
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is certification is valid thru (date) �2� 9// i