Milliken

CERTIFICATION OF EXEMPTION
FROM REQUIRING A CAMA PERMIT
as authorized by the State of North Carolina,
Department of Environmental Quality and the Coastal Resources Commission in an area of
environmental concern pursuant to 15 NCAC Subchapter 7Ko1O3 or NCGS 113A-103(5)(b)(5)
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Applicant Name '`A k e ' Phone Number
Address 1-j C fi C t'1,. ! 1 C k. (.,U 1 j,A) ;
City k 6,IIo-tic_ State N C-- Zip 2 11 O
Project Location(County,State Road,Water Body,etc.) ,A , �` J��<,�\�}�� 2�`� u� F
Type and Dimensions of Project l-e r A oL-,�` ^\ A E_ c,1 ,�_j ' S--- �U ter.-.+-
The proposed project to be located and constructed as This certification of exemption from requiring a CAMA permit
described above is hereby certified as exempt from the is valid for 120 days from the date of issuance. Following
CAMA permit requirements.This exemption to CAMA expiration,a re-examination of the project and project site may
permit requirements does not alleviate the necessity of be necessary to continue this certification.
your obtaining any other State, Federal,or Local
authorization.
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Any person who proceeds with a development without the con- Sr,,,_ A \-1:<,
sent of a CAMA official under mistaken assumption that the App j 's si nature
development is exempted, will be in violation of the CAMA if there s"'')� — ,
is a subsequent determination that a permit was required for the �J
CAMA Offi ial' signature
development. 9
The applicant certifies by signing this exemption that the 1 1 ''', fyz_O 31.; ZU21
applicant will abide by the conditions of this exemption. Issuingd te P
Ex iratiorl�Date

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. s •
CERTIFICATION OF EXEMPTION
FROM REQUIRING A CAMA PERMIT
as authorized by the State of North Carolina,
Department of Environmental Quality and the Coastal Resources Commission in an area of
environmental concern pursuant to 15 NCAC Subchapter 7K0103 or NCGS 113A-103(5)(b)(5).
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Applicant Name alvkke i\V I ( 4 (R\`^ ) Phone Number lu S-4
Address L(c'}-$ C hwLw tct'C. Lo4.1 \ ) ;
City S kaU/`+ State N Zip Vice
Project Location(Cou(�}`,f. State Road,WatercB'o,dy,etc.) 1-dam es R `�t��` �t`�'�
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Type and Dimensions of Project (�sQ� 4 �0 0C 1p 11,153 s1�►e o4 X,•,
The proposed project to be located and constructed as This certification of exemption from requiring a CAMA permit
described above is hereby certified as exempt from the is valid for 120 days from the date of issuance.Following
CAMA permit requirements.This exemption to CAMA expiration,a re-examination of the project and project site may
permit requirements does not alleviate the necessity of be necessary to continue this certification.
your obtaining any other State,Federal,or Local
authorization.
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Any person who proceeds with a development without the con-
sent of a CAMA official under mistaken assumption that the s si
development is exempted,will be in violation of the CAMA if there
Is a subsequent determination that a permit was required for the
development. • CAMA Offi lei' signature
The applicant certifies by signing this exemption that the i ') 7..(57-0 3 ; 2 ozi
applicant will abide by the conditions of this exemption. Issuing d to
Expiratio Date

11/3/2020 Mail-Brock,Brendan 0-Outlook
North Carolina Department of Environment and Natural:Resources
• Dvislwr.of Coastal Managemefit
Pat McCrory Braxton C.Ds. lohn=E Skverb,III
Governor Directory
AGENT AUTHORIZATION FORM
Date: g`%'S)'"0?4d-e)
Mama'of Property Owner Applying for Permit: Name of Autlrorized;b► t enfor thiisst;project Owner's Address Agent's Milting Address:
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Phone NumberC9/0) 7c4' - 9..5 7 Phone Number(Qla ) 3I %/I
I certify that l have authorized the agent listed above to act on my behalf,for the-purpose;of applying
for and obtaining all CAMUMA Permits ne essary to install or construct the following-(activity):
pe:s.ar- e
For my property locsibailat
This ceEficatlon is valid thru(date) d ti 6,, O ? .2O /.
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•
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Platy Owner Sigraafiare Date
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