Stewart

' CERTIFICATION OF EXEMPTION
_Y FROM REQUIRING A CAMA PERMIT
\ as authorized by the State of North Carolina,
0 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 CO . ,.9ti 7 /O L h,a f Ps /f)/' a e f Phone Number%
r /0)7r/Y—25
ass ; Z0) OC d (c,r9 iJ f2,,9.d
t / Lt. /Ads ¢lip State , ' .. Zip 2 2:
ct Location(County,State Road,Water Body, etc.) 13 O Th,"a Da-1 R d�Rc ,_ I r, me4- #4
u / ex
and Dimensions of Project R epc',9t e AL f l ' S.e C%'C.,^' 0 'Q., CX , x 1,~S B`'t'r
>roposed project to be located and constructed as described This certification of exemption from requiring a CAMA per
e 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
Beverly Eaves Perdue James N.Gregson Dee Freeman
Governor Director Secretary
/ AGENT MEMORIZATION FORM
Date:
Name of Property Owner Applying for Permit:
Mailing Address:
Sao _Q►d CIQ0S f2ocJ
L- i( 4D( , NC '5y6
Phone Number: (VII ....R 9 - 1799 Q _
I certify that I have authorized (agent) Zjc / to act on my
behalf, for the purpose of : •plying for and obtaining all CAMA Permits necessary to install or
construct(activity) i ':. 4 gT
at(my property located at) 130
This certification is valid thru (date) ‘/11 ,4
7/ 17-D y
Property Owner Signature pate

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Existing Dock
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