Cain

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.
IicantName P-P4 't se'e ����✓ / �P�tblo� pw.✓ Phone Number" 4 8S
ress Z 'tl t #Af hewlcl
` ,* State Zip 2
ect Location (Countx, State Road, Water Body, etc.) ,
f i i �✓ el chc
9 and un nsions of Hroject ./ > ! l I✓' o /-1 Q iv, e od
proposed project to be located and constructed as described
,e is hereby certified as exempt from the CAMA permit re-
ament pursuant to 15 NCAC 7K .0203. This exemption to
1A permit requirements does not alleviate the necessity of
obtaining any other State, Federal, or Local authorization.
This certification of exemption from requiring a CAMA pe
valid for 90 days from the date of issuance. Following expi
a re-examination of the project and project site may be nec(
to continue this certification.
ETCH (SCALE: 2 D

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800-845-1120 H o l c i m www.holcim.us
J' Oct
eC' dT� r.SI' W&!l

10 01:58p Greg Amsden 8648888126 p.1
111t/701Ed U1:4b I%Jlb/54542J JMh'AXKLK CAUL dl/ul
A LVX.
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North Caroka Department ot-E6y46nrnent and Natural Resources
Division of Coastal Management Freeman
Beverly Eaves Perdue James H, Win. Secretary
Governor b;rec0os
GENT AUTHORI !Qt FORM
Date: r
_N�rr�e of P c)% .per Apfixtnq for Permit: N e of Authorized Agent forthis project,
J
Owner's Mailing Address: Agent's Mailing Address:
Jt,t; 4 S(ALL C�t►J +��
233 Z W i e- VVN RZOLA t2
-72
Phone Number 8k4�. S - 0 3`) Phone Numberte
— 1 j
I certify that l have authorized a* agent fisted above to act on my behalf, for the purpose of applying
for and obtaining all CAMA Permits necessary to Install or construct the following (activity):
E tip A 12, V;, ja L-Y- e-vaD
(mY Property located) at _ (� � �S�1NF �(Zb _ _ S`T t-�C -- $ Ac l-) N C—
his cerVdication is wand thru (date) r 1 l
Property owner S;igna� re Datb