02287D - Watanasiriroch

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Tress '�I"
CERTIFICATE OF EXEMPTION
FROM REQUIRING A LAMA PERMIT
021,
as authorized by the State of North Carolina,
Department of Environment and Natural Resources and the Coastal Resources Commission
in an area of environmental concern pursuant to 151 NCAC Subchapter 7K 6103 , I;�
] , �(�i S,VI�OLh CIS avkv St fkt Yh Y6VTMRhone Numbelo(
Location (County, State Road, Water Body, etc.
e and Dimensions of Project
)roposed project to be located and constructed as described
is hereby certified as exempt from the CAMA permit
rement pursuantto 15 NCAC 7K 6. 16 3 . This exemption
\MA permit requirements does not alleviate the necessity of
obtaining other State, Federal or Local authorization.
Zip
This certification of exemption from requiring a CAMA p,
valid for 90 days from the date of issuance. Following exp
a re-examination of the project and project site may be ne
to continue this certification.
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EXMSTIN
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21-2013 08:50 FROM:WILLIAM CARTER 9107547828 TO:19103953964 P,_%2
PRA
C DE R
North
Carolina Department of Environment and Natural Resources
Pat McCrory Division of Coastal Management
Govornor Braxton C. Davis John L Skvarla, I
D1f ector Secretary
A ENT A T RIZATI FORM
Date: /( l? 13
ame of Property Owner A plying far Permit:
5'�t j a n Yv rQJtQ'St �t I ��t']
Amer's Mailing Address:
1a h R e
1a _ G . 'DIV -2 -76
one Number 0 v
Name of Authorized Agent for this project:
4r- J', .
W4'�WS YM J-7rt�rtiv�ir1�/t
Agent's Mailing Address:
On VW
WOO
Phone Number ��Ia l �[+�
jrtify that I heve authorized the anent listed above to act on my behalf, for the purpose of a
and obtaining all LAMA Permits necessary to install or construct (activity):
the followingAPIY�ng
ty):
my PraPerty located at 1.�,
I certification is valid thru (date)
Property Owner Signature pate
a���

21-2013 00:50 FRCM:WILLIAM CARTER 9107547828 TC:191039530-64
P.2/2
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