02139D - Fish

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CERTIFICATE OF EXEMPTION
1 FROM REQUIRING A LAMA PERMIT 02
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 15 NCAC Subchapter 7K . W3 ,
licant Name
ress `7 a
ject Location (County, State Road,
kC), i ,, rk Am V
e and Dimensions of Project
Body, etc.)
,r
proposed project to be located and constructed as described
e is hereby certified as exempt from the CAMA permit
airement pursuant to 15 NCAC 7K, r 2 .This exemption
:AMA permit requirements does not alleviate the necessity of
r obtaining other State, Federal or Local authorization.
Phone Number
State IvL Zip
This certification of exemption from requiring a CAMA
valid for 90 days from the date of issuance. Following ex
a re-examination of the project and project site may be r
to continue this certification.
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Applicant Name
Addro
City
CERTIFICATE OF EXEMPTION
FROM REQUIRING A CAMA PERMIT N° 02139P
as authorized by the State of North Carolina,
Department of Environment and Natural Resources and the Coastai Resources Commission
In an area of t^nvlronmcmal concern pursuant to 15 NCAC Subchapter 7K10ka. ,
rta rl,S1vRAkAs. KVi,ytfl Phone Number :it+.I bi
State_ Zip
State Road, Water 130q. etc.)
tMAur, 1MhAt VAVi
Type and Dlmenslona Of PrOJed
The proposed protect to be located and constructed as described This certfication of exemption from requiring a CAMA permit Is
above Is hereby certified as exempt from the CAMA permit valid for 90 days from the date of Issuance. Following expiration,
requlrementpum ant to 15 NCAC 7K,JtL - This exemption a re.examIH UMV of the project and project site may be necessary
to CAMA permit requirements does not allevlate the necessity of to continue this certification.
your obtaining other State, Federal or local authorization.
E ! )
SKETCH (SC AL
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Any poroon who procoods with a dovobpmont without the con -
cant of o CAMA oftkial undor Iho mictakon aooumpuon that the
dovoiopmont to oxomptod, wla be in vlolption of tho CAMAli thoro
io a subooquont detorminalbn that a pormlt woo roqulrod for tho
development.
Tho applicant eorlitiao by ohpning this oxemption that (1) tho op-
pl(cant hao road and will abldo by tho conditions of this exomp-
lion, an
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Expiration dote
Attachment: 15 North Carolina Administrmivo Code 7K
RGC :FIVED . -I ' 1i1

16-2012 14:23 From:THB ADMIN 91OE429315 To:19103953964 P.1/2
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