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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.
cant Name jk'he,i/ ,9 h'oLdom'. 7, 'A (4 i-.-' f% Phone Number i0)272-S-5
ess /y y y/y c.i f 14/AiCN )4 ,u,a
/k Lc ow 6 r_gc h State ," ,- Zip ..27.,
!ct Location(Co/unty, late Road, Water Body, etc.) Piz/ Y.Acii 4✓4TCA/i . ,y J ,,,:c, _:; u
N,,GriI.✓ 8"Q( A 62HNf .t ...
cd#47 ,
and Dimensions of Project /< �9�i2 f i?oiel4cf' [ x /Sib" "24971,�' .Doc
roposed project to be located and constructed as described This certification of exemption from requiring a CAMA per
is hereby certified as exempt from the CAMA permit re- valid for 90 days from the date of issuance. Following expir;
rent 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.
)btaining any other State, Federal, or Local authorization.
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Ar74,A.
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue James H.Gregson Dee Freeman
Governor Director Secretary
AGENT AUTHORIZATION FORM
Date: G 2 e
`Name of Pro arty Owner A plyin for r
Ltotta..-1-Asua.,$),IA_
Mailing Address: s�
/Yy YA J.�� -c/ D!ejj/C
Phone Number:( /D 1 ,279-..)J. 9y Z.,. •
I certify that I have authorized(agent) fy kar'iL<- re,..1- to act on my
behalf,for the purpose of applying for and obtaining all CAMA Permits necessary to install or
construct(activity) L,�;ti+,.' pr X R r` r:Lr r 1i ,l c;c:r a+
at(my property located at) I`H crc.A 1-4ta fc,
This certification is valid thru(date)_ /2 }f C / •
�5� ct,u>ttecI - 7 n9
Property Owner Signature Date
127 Cardinal Drive Ext.,Wilmington,NC 28405 ne
Phone:[phone] FAX [phone] Internet:wew.nccoastalrnanagement.r�t fl CaIOlina
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