Hunnicutt

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.
icant Name eok 1/W Ca / Ka Je Lo a!"v17`, Phone Number-
ess ; 2 0 7-he F�'PS'�ol
State A L: Zip 2 7;
act Loc tion (County, State Road, Water Bondy, etc.) Z L c Q ^� ell
and Dimensions of Project N�/D/ / N ry �� e -nods *f P v,467r7e,.� v .- �,+� t� •-c
>roposed project to be located and constructed as described
e 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 alleviate the necessity of
obtaining 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.
ETCH (SCALE:
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NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management Dee FrE
Beverly Eaves Perdue James H. Gregson Sec
Governor Director
AGENT AUTHORIZATION FORM
Date:
Name of Property Owner Applying for Permit: Name of Authorized Agent for this project:
Owner's Mailing Address:
Via, �
Phone Number
Agent's Mailing Address:
t� &CLC. 1 D:- OW
Z 4(DV
Phone Number
I certify that I have authorized the agent listed above to act on my behalf, for the purpose of applying
for and obtaining all CAMA Permits necessary to install or construct the following (activity):
(my property located) at y3a. aL�`t
This certification is valid thru (date)
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Date

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