Van Tassel

CERTIFICATION OF EXEMPTION
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. p
Phone Number 1 , • Ic� 0- 0
and Dimensions of Project
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 expin
nent pursuant to 15 NCAC 7K .0203. TNs exemption to a re-examination of the project and project site may be nece!
a permit requirements does nofallevt�t the necessity of to continue this certification.
)btaining any other State, Federal, or Local authorization. 10\41Ft2 FjLF .. 107-0 11 A
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North Carolina Depart
Beverly Eaves Perdue
Governor
Name of Property Owner Applying for
-o - „ i, „, a 11P l kv tin ri `Ta
Owner's Mailing Address
Phone Number All. goo
I certify that I have authorized the agent li
for and obtaining all CAMA Permits nece.
/ / /.
(my property located) at
This *certification is valid thru (date)
I e A' A I /
property Owner Signature
LIMA
AP
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lent of Environment and Natural Resources
on of coastal Management
James H. Gregson
Director
Dee Freemai
Secretar,
e: 1015111
Name of Authorized Agent for this project:
Agent's Mailing Address:
Phone Number 30
above to act on my behalf, for the purpose of applying
to install or construct ttte folloyAng (activity)'
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Date
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09/2010 04:36 9105799096 GRICE CON PAGE 01
CERTIFICATION OF
EXEMPTION
FROM REQUIRING A LAMA PERMIT
as authorized by the State of North Carolina,
Department of Environment, Health, and Natural Re
in an area of onvironmental �rn pursuant to 115
urces and the Coastal Resources Comml$Wrr
CAC Subchapter 7K-
scant (
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PhoneNumber" o
State zip
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act Loaklion (Counly, State Road, Ater body, Inc;)
i and DimerwWons of Project
xopoead project to be located and constructed asdescrlbed Thl
e is hereby certified as exempt from the CAMA permit rep- Vail
certification of exemption from requiring a CAMA parr
I for 90 d a from the date of Issuance. Following expire
be
ment pursuant to 15 NCAO 7t< . Is exemption to a r
A permit requirements does Heir a dXhso nowaslry of to
xam n n of the project and project site may neces
n0nue this c4rtlflcation.
obtaining any other State, Federal, or Local authorization.
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