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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 115 NCAC Subchapter 7K .0203.
licant Name ftl& 15 od'f �". �0 Phone Number''33 .2 •�
ress o t 41,e f -A L 4V f ,
State -IV C Zip
ect L cation unt,, State Road, Water Body, etc.) S S d y
and Dimensions of Project ;r-N C /A l t /Y e d Z),vA 01'V'- -' //�A z- ,
art r h � u.r S !;I —j', i �_0-1IR"/'PA/A J -t , . C'/. _ //4
proposed project to be located and constructed as described This certification of exemption from requiring a CAMA pe
,e is hereby certified as exempt from the CAMA permit re- valid for 90 days from the date of issuance. Following expi
?ment pursuant to 15 NCAC 7K .0203. This exemption to a re-examination of the project and project site may be nec(
IA permit requirements does not alleviate the necessity of to continue this certification.
obtaining any other State, Federal, or Local authorization.
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Message Conf irmation Report
Name/Number
98429315
Page
1
Start Time
OCT-15-2010 09:28AM FRI
Elapsed Time
00120"
Mode
STD ECM
Results
[ O• K]
OCT-15-2010 09:29 AM FRI
Fax Number
Name
CERTIFICATION OF EXEMPTION
_Y FROM REQUIRING A CAMA PERMIT
as authorized by the State of North Carolina,
Dopartment of Environment. Health, and Natural Resourcoa and the Coastal Resources Commission
In an area of environmental concern pursuant to t6 NCAC Subchapter 7K .0203.
Applicant Name r�,r ,r i112d 1..� LG +40 Phone Number(Z -,' 33
Address o 6✓
City IS a ZIP 2 72
Prolect Ldcatlon LCDunty. State Road, Water Body. etc.) _ �'
Ta, a and OlmenJslons�Qqt Project tw d
yge
The proposed project to be located and constructed as described
above Is hereby certified as exempt from the CAMA permit ro•
qulrament pursuant to 16 NCAC 71K .0203. This exemption to
CAMA pormit requlremonle does not alleviate the necessity of
your obtaining any other State, Federal, or Local authorization.
CO-A-7
This cortification of exemption from requiring a LAMA permit Is
valid lot 90 days from the date of Issuance. Following expiratlon,
a re•e%aminatlon of the project and project site may be necessary
to continue this certification.
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F J8;20104RI 04:47 PM HYLTON CROWDER FA'A No,336 882 0135
QCT-0B-2010
14:45 From:THEI PLAN&INSP gioa427003 To:336 ME 0135
' rpkb:�- uW;160'(J
r
Beverly !naves Perdue
Governor
P. 001
P.2/2
N�
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
James H, Gregson Dee Freeman
Director Secretary
AGENT AJ IUT,HORIZATION FORM
Date: r a
N e of Prrop" Owner Applying for Permit_ Name of Au1 W ) — ae- r:a.thorizeA gent for this project:
y
Owner's Mailing Addr ss: n
7J
Agent's Malting Address:
7Z4t /. -Z
Phone Number. Phone Number &n)
I certify that 1 have authorized the agent listed above to act on my behalf, for the purpose of applying
for and obtaining all CAMA Permits necessary tp install or construct the following (activity):
(my property located) at
This certification is valid thru (date)
Pr6perty Owner Signature Date
RECEIVED
DCM WILMINGTON, NC

r/38;2010/FRI 04:47 PM HYLTON CROWDER
)CT-08-2010 14:44 From:THS PLRN&INSP
FA'A No,336 88.1 0135
9108427003 7o:336 8B2 0135
F. 002
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