Upton

CERTIFICATION OF EXEMPTION
-v
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.
licant Name /3d %-a'a XD X/l,cP ('0Ns7��!/CTi�.v Phone Number /0 S S -
ress i S C,,jcAid S
P State Zip 2f
ect Location (County, State Road, Water Body, etc.) ..� S vo �i�.� -
and Dimensions of Project IL ZY 'P Q i ds. + l e A n, r.v A S e'e dod
c - L- " ; , . Za L//h -"Od'
proposed project to be located and constructed as described
e is hereby certified as exempt from the CAMA permit re-
�ment pursuant to 15 NCAC 7K .0203. This exemption to
IA 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 expii
a re-examination of the project and project site may be necE
to continue this certification.
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-- -- - . , r,rt r it Pr'tc rqs
bw-oon of CNVtal M apernent
Beverly !raves P: "h r 1 k r ! } • r r ;'-a
Goysmor 1031W r I
I
Narno :,f amFW''1' nw'N"r Af;plyInn for Permit:
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Owner's MaYlfig Address.
earL
5 I e.
I certify that I nave suftriied the agent fisted above to
for and obtaining ali CA." As Perml.'s rmresaary to install
(my praperty located) at
This 'e-v,-d1fication is valid thni (date)
ir` pwrty C•�:ee t �i j�la'�Ire
of AUUIL-lreu P
i C-P C;o�
Q 4/sl/_/n_nAddreSS:
Number ql4 v1 -O t
on my behalf, for ine pucpu- a
r.•r a:x. 'he following (actIVIty):
Date
G i B
/Ca, olvi fJ
Doe Freeman
Secretary

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