Jordan

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
r� in an area of environmental concern pursuant to 15 NCAC Subchapter 7K .0203.
cant Name She L b�, CvNJ7rs7wcAe,,v Phone Number `>/d 2%6'i
ess / Z 4G // L4 Yo
' State N Zip
act Location (Cou ,State Ro� Water Body, etc.) �` C✓, C .,� , �� .� Sf, A al 19CprT ? o
'41
and Dimensions of Project > o c. a de,4dIve, v 0—
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roposed project to be located and constructed as described
a is hereby certified as exempt from the CAMA permit re-
'nent pursuant to 15 NCAC 7K .0203. This exemption to
4 permit requirements does not alleviate the necessity of
)btaining any other State, Federal, or Local authorization.
This certification of exemption from requiring a CAMA per
valid for 90 days from the date of issuance. Following expin
a re-examination of the project and project site may be nece.
to continue this certification.
_TCH (SCALE: 7720

zo u u:+,z is ,>cooTer p.]
<na i3trNas'vnant �"Or I nAMA-
tamdNp tyral kesoul.x�
0IY15i011 �k-..... Adr�'�3 r",e t' Ne freeman
Governor
AGENY AUTHOR,
ate:*
t�;;f, �r� �f .A�t'�rsr sFd A,ant `or this p �jecr
Name of Praper�� �,; r� o �9f r.j.j+ j �j �5► i Ur rerr-�,,. , }
C_)wn6r'c M*1Pr; j Address:
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Phone Nunlbe(Alw
l cerVy that I have aithorized the agent listed above to
for and Cbta'.ninq all LAMA Permits
lf�o .�r•� tom- �GU• tiv��S
(my property ioc,atav) al
This certification is valid thru (date;
Property npt' Signature
t\
A .n: • Afia
Ze
Ph ne Number (��? ` `=-Cla YS
ary to lobtail or
0,.4 -y 4�,et,:alf fnr the pu,posE. of applying
njGtructtPle following (3ctivitv).

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