John Shadid

CERTIFICATION OF EXEMPTION
FROM REQUIRING A CAMA PERMIT
as authorized by the State of North Carolina,
Department of Environmental Quality and the Coastal Resources Commission in an area of
environmental concern pursuant to 15 NCAC Subchapter 7K•oicr5 or NCGS 113A-103(5)(b)(5) .
Applicant Name t-tA N NAD 1) Phone Number (girl) 575- 34 OO
Address 2E Agtvl '-e.. 77-rrzc sri ;
City OC VA, sL.E.- P.CAC N .....,� State Akta-iI-1 CAPocl.J{I Zip 2>z46,I
Project Location(County,State Road,Water Body,etc.) �' i `' �`'wlC C�'! NI-y /
, :
Type and Dimensions of Project
R .. ,C pAgz V cILKbicAv oil EAsv r I;,r c r [.�
FA<14G -rI_IC.- CAn/AL.
The proposed project to be located and constructed as This certification of exemption from requiring a CAMA permit
described above is hereby certified as exempt from the is valid for 120 days from the date of issuance.Following
CAMA permit requirements.This exemption to CAMA expiration,a re-examination of the project and project site may
permit requirements does not alleviate the necessity of be necessary to continue this certification.
your obtaining any other State, Federal,or Local
authorization.
AEC(S): 6 S * 1-`7 SCALE: ; 11 s ::?-0
I 1 1 1 1 1 1 ,4040-010
II 1 1 1 I ZJ
1 I ♦• I+r�'1 I 111111 I 1 I 1
I•--I---I---I- --r--r --}--+--}--+--f--t--t--t--+--F-1---+--+--t--+--F--t--1-- -t--4
I I I 1 1 If' I I 1 I I 1 I I I I 1 1 1 1 1 1 1 1 I 1
h--r--r- r--
Ar t t 4--t-4-- --1--r-- __:___f +s#y1 t--t--t--t--1---t-4_1,_--r- 1
I 1 1 1 1 1 I 1 1 1 1 1 •O'Yx Ip/ rI ,LYI 'Dol
I I 1 I I 1 I 1 I 1 1 rJl l' OhM
rr
-r -r--t-- - � - rt-- -- -- - -- --t- -rt--t-- --t- -r--r--ti I 1 1 I1 1 1111 1 I 11 I I 11 I II I11I 1 1 I-r-- --1 -1- --t--r--t--�- --T--r--T--r-�---r--r--t--T--r--r--r--
I I I 1 I I I 1 1 1 1 1 1 1 I I I I 1 I b--1 1
1 1 1 I 1 1 ,�1r.r.���l;r� 1...__ L._.__L1_ -r : ij :
r r--r rr --r- --1- r -f'!
1 1 I I I I I1 I ;' I I I I I I
I I _ I 1 I I 1 __ _ R_OF `>�E-� I 1 11--r-- 5{ti1 r""T--T- -- - r--T T r - __r__1tr„,....,,,t„,...,A.
- --r--1
I 1 I I,,,� 1 1 1 1 I 1 1 I 1 Qr ij1Mi.r1 Qf1�4...,A, ..�L,c,i 1 i i 1
1 �1 I 1 1 I 1 1 III 1 '
;fir--r -t-- --r- r 1 1 1 1 1 I -- __i _1 •
-- -- - - -, - -� - -�r-�;
1 I 1 11,E I I I 1 I 1 I I , I I I 1 1 1 1 1 1 I ►1.� �.1
j-I-L--L- I,- -L- 1---L--L--1--1---1--1-- -R+f.,1-in,
,-`/1 1 I I 1 1 1 1 I I 1 I I I I I I 1 I I 1 1
I 7�J I 1 I (1r I I I 1 1 I 1 I 1 I I 1 1 I I 1 1 I 1 1 �1 1
_ _L_ Fat - Ir, _L__L__1_-L__J.__1__L__1__L__1__L_J___1__1_-1__1__L__1__L__ _�L_ IJ
I 'Gl I I „r I N I I I I 1 I I I I I I I 1 I 1 I I I 1 ''1 -,I
I --I I I Q I L-
� I 1 I I I I I I I I I 1 I 1 1 I I I I �I � 1
L _L _L _1 L"_j.__L__L__J.__L__J.__1__L__1__L__1__L_J___L__L__1__1__L__1__L__ _ L "J
I I I �" I I F 441. 1 1 1 I I I I I 1.. I 111111 1 I '.1 - .1
II I I T I 13e I.$ I III I I f I 1 /jl 1 1 1 1 1 1 I 1 1 li
jl I
L_ __ __L_ J._ ..L,L__L__L__1__L__1__1_ __1__LL_5__L_J___1__1__1__1__L__1__L__ ,.�L_ J
I 1 I I * �' I f I I I - I "'/ (f�� 1 I I I I I 1 •I I -moi �,1
1O'- --1' ��JI-_L_ � --1--1--1--1--L'--1--1--- --L
LL:LL4::
-�--L--1 --}--1 --*--�--�-- 1--4--�--1-- ---�--�--;--;--1---�--�-- --I- a
FHH1
1I II F4Ffr+J 11 11 11 11 1111111111 I 1 I 1 1 1 1 I I I
f -..
I
Any person who proceeds with a development without the con- 1 � 1.+-
sent of a CAMA official under mistaken assumption that the Applicant's signature �7
development is exempted, will be in violation of the CAMA if there ,�/
is a subsequent determination that a permit was required for the y
development. CAMAaOffii ial's signature', 4
The applicant certifies by signing this exemption that the 07 ,20I Y 17117/,Z Of$`
applicant will abide by the conditions of this exemption. Issuing date Expiration Date

•
Kam�
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Pat McCrory Braxton C. Davis John B.Skvarla, III
Governor Director • Secretary
AGENT AUTHORIZATION FORM
Date:
Nret of Pro erty Own r Applying for Permit: Name of Authorized-Agent for this project:
,..) r) b\-\CI.C1kC eTtc.z• c3q5-tritc_ton
Owner's MailingAddress: �� Agent's �
al -01\sz\t
l Cric6bbl f S�
Q)-la(tct, oC-Q-C-tr‘
NCC 21`t .__ . NC Z`i% �
Phone Number( bif ns-31-(C) Phone Number elPi Feto c,cr
I certify that I have authorized the agent listed above to act on my behalf,for the purpose of applying
for and obtaining all CAMA Permits necessary t install-or construct the following (activity): I
a 1 J � . �� ti p,\.1 dor, l \�11
f
�(�SL4JJ n cU 1/ cot C t ' rl ' s
myFor property located at _� `>r"ZY( 6
/
This certification is valid thru (date) v a m v $
4111
ate10
Props:y Owner Signature D -----
•
•
12?Cardinal Drive Ext.Wilmington,NC 28405
Phone:[phone] FAX:[phone] Internet www.n6coasIalrnana.emenl.net
An Equal Opparlunily 4 M6rnmfive Aclion r:n oyer

2t B \,\Q.\ \\IL
0,cssvx-\ ___Vsvc? 4111.1
2----- Coo-N-(1 )
\t3 6\A/ V)\-\\\
- �.\1 ��J c- AS