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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.
Iicant Name >OS Cop/V P, /)J,Z , n,, c %i , k Phone Number 9/rr V2 0.—r
ress Z 9i &.9gle.-A oed
r P �✓ , c c State <- Zip 22
ect Locationl�ounty, State Ro}ad, Water Body, etc.)
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Brand Dimensions of Project
proposed project to be located and constructed as described This certification of exemption from requiring a CAMA pe
fe is hereby certified as exempt from the CAMA permit re- valid for 90 days from the date of issuance. Following expi
ament pursuant to 15 NCAC 7K .0203. This exemption to a re-examination of the project and project site may be necE
IA permit requirements does not alleviate the necessity of to continue this certification.
obtaining any other State, Federal, or Local authorization.
ETCH (SCALE:
A01
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue, Governor James H. Gregson, Director Dee Freeman, Secretary
Date OG 2 0 / D
Name of Property Owner Applying for /Permit:
Mailing Address:
'13 2 9 &Arker
A14 w 8" 1. NC } 2 7 ri" 2
I certify that I have authorized (agent) & C t czvll�'J rlaIz� V) to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity) )Dq `VV)e.�
at (my property located at) G W r I m< n 9 t0G &4..^ T c p 6 j A
This certification is valid thru (date)
/o-r=Zoio
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