02202D - McBride

CERTIFICATE OF EXEMPTION
FROM REQUIRING A LAMA PERMITS 0Z
as authorized by the State of North Carolina,
Department of Environment and Natural Resources and the Coastal Resources Commission
in an area of environmental concern pursuant to 15 NCAC Subchapter 7K I L
>licant Name JL1 GrnG\�o%n A94 (emu C� k5A-. Phone Number
cress JY,( �i %l-1rVA ck►x A K i V t-
f /VlutlrliC
Ict Location (County, State Road, Water Body, etc.) -
1p i + - I^o( 'C.1
ie and Dimensions of Project C\-<1�4Ir
proposed project to be located and constructed as described
e is hereby certified as exempt from the CAMA permit
Irement pursuant to 15 NCAC 7K . (11.2 . This exemption
AMA permit requirements does not alleviate the necessity of
obtaining other State, Federal or Local authorization.
State i
i (T'—(,GU'4
PA
This certification of exemption from requiring a CAMA r
valid for 90 days from the date of issuance. Following exl
a re-examination of the project and project site may be ni
to continue this certification.
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;/03/2011 19:25 9105799096 GRICE Cal PAGE 02
North Carolina Department of Enviro,
Division of Coastal M
Beverly Eaves Perdue James H. Gm
Director
Governor
Date: 5' k�
Nam of grope Qwner Appl ing for Permit:
Owner's Mailin Address;
//0
Phone Number
I certify that I have authorized the agent listed above to
for and obtaining all LAMA Permits necessary to install
(MY property located) at
This certification is valid thru (date)
n �
l�
a.•..nw+v owner Signature
and Natural Resources
Doe Freer
Secre
7�f Aut rized Agent fa this project:
rnt's Mailing Address:
pione Number
on my behalf, for the purpose of applying
�nnstruct the follovying (activity):
Sf . 1 a/6 f /VG
Date