Wilson (3)

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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)5 NCAC Subchapter 7K•EIO; or NCGS 113A-103(5)(b)(5) .
•
AApplicant I�� ' ` W t un Cc/0
• i/`I SGI
pp Phone Number
Address ' \ !r i P/' c
City ()cc"- (s j t_ (,)<-t t-. Stt/ll N ate - . Zip -2 71-- 1 l' 1
Project Location(County,State Road;Water Body,etc.) ; ' i
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Type and Dimensions of Project 17 c.'
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The proposed project to be located and constructed as This certification of exemption from requiring a CAMA r rmit
described above is hereby certified as exempt from the is valid for 120 days fromthe date of issuance.Hollowing
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 A 's signature ,.%
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 ial's si nature
The applicant certifies by signing this exemption that the 5 23 �2 d2 l> IZ.S 1? „rsJ
applicant will abide by the conditions of this exemption. Issuing dale Expiration Date .�

AGENT AUTHORIZATION FOR CAtVIA PERMIT APPLICATION
Name of•Property Owner Requesting Permit:
Mailing Address: (3 ZA
.O/4 , vG ZS la q
Phone Number: S.W • Litf 3C0: Lf
Email Address: (5 Aks/Sv s : - - c C? ,tea: /,
I certify that I have authorized 6 le'' 6D s"?'"
Agent/Contractor
to act on my behalf,for the purpose of applying for and obtaining all CAMA permits
necessary for the following riroposed development: "
at my property located at 357 s�E 7L D/ 6, /vG
in 13. 144/5.ks4t,14---- County.
C furthermore certify that I am authorized to grant, and do in fact grant permission to
Division of Coastal Management staff, the Local Permit Officer and their agents to enter
on the aforementioned lands in connection with evaluating information related to this
permit application. •
Property Owner Information:
;AinL —
Signature
Print or Type Name
Title
5` / /3 /
Date
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This certification is valid through I /

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