01208D - McGirt

CERTIFICATE OF EXEMPTION
FROM REQUIRING A LAMA PERMIT 01
as authorized by the State of North Carolina,
Department of Environment and Natural Resources and the Coastal Resources CorgLpmon
in an area of environmental concern pursuant to 15 NCAC Subchapter 7K 010 3.
)licant Name
cress i 6
ject Location (Coui
►e and Dimensions of Project
,t1- Phone Number
Q State
Road, Water Body, etc.) I I D Z 1/n\
proposed project to be located and constructed as described
e is hereby certified as exempt from the CAMA permit
Irementpursuantto 15 NCAC 7K �'I q%. This exemption
AMA permit requirements does not alleviate the necessity of
obtaining other State, Federal or Local authorization.
k
This certification of exemption from requiring a CAMA r
valid for 90 days from the date of issuance. Following exr
a re-examination of the project and project site may be ni
to continue this certification.
(ETCH (SCALE:
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North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Pat McCrory BraxW C. Davis John E.
Govemor Dkec for Se
AGENT AUTHORIZATION FORM
Data: %/ 2 -�
Name of Propwty Ownw Applying for Permit: Name of Au wwked APIA for this projec
Phone Number L 2054 6 P c�,(c� %
I cartify that I have auftrtsd the agent NeW above to act on my behalf. for the purpose of applyin
for and gpisining al LAMA Pern*s rwo emy to it or consbW the following (activity):
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