Town of Holden Beach

►/V M At t_ Eo
t 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 .*2"r NCGS 113A-103 (5) (b) (5)
Applicant Name __ro w N o F 140 (.DEN BEAcN Phone Number (q 10) 842' & O$o
Address Nt'Ly .5-rRaE7 ;
City NU1.- 1)V H 8E A c N State we Zip
(County, State Road, Water Body, etc.) $R LWso ► rt K C a" n/-r y
OC E AV Flv L c r_ " $ps A c .A — -r. w _i £roc 1-%Av- m-r
!%A IT LA C (S EA C O A r c r Ss To A-r L A � : I c QC IG A.W
Type and Dimensions of Project f7 e
}Z EV(-AC1i r— eISTi"e-, AG«.S fi_1,A%j Y Tc-IV%
WA
The proposed project to be located and constructed as
described above is hereby certified as exempt from the
CAMA permit requirements. This exemption to CAMA
permit requirements does not alleviate the necessity of
your obtaining any other State, Federal, or Local
authorization.
This certification of exemption from requiring a CAMA permit
is valid for 120 days from the date of issuance. Following
expiration, a re-examination of the project and project site may
be necessary to continue this certification.
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,(o7%2 OciE.AN 8(,vo W.
Any person who proceeds with a development without the con-
sent of a CAMA official under mistaken assumption that the
development is exempted, will be in violation of the CAMA if there
is a subsequent determination that a permit was required for the
development.
The applicant certifies by signing this exemption that the
applicant will abide by the conditions of this exemption.
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Applicant's
✓signature
nt
CAMA O cial's signature
5/7a19 9 /7/014
Issuing date Expiration Date

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.0_ 4e?br NCGS 113A-103 (5) (b) (5)_.
Applicant Name � W a a F 140 PPE-H
&--ACA Phone Number (q 10) $42 , & 080
Address t ACT&%sc-A I Ly _,"V *%T
;
City _,ppL 0,rW 56,A G N
State Zip ;291442_
Project Location (County, State Road, Water Body,
etc.) SRt�VSL+ t c K C-*",yT y
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s vtil-v
i7utIIWC. ScAi: 4 Acco ss
W IC DC&,%W
Type and Ditnensions of Projed
rmlizrieya,
AGIG'lR.J Jr Iwlihl O: T�/1♦'Q
14A.1atc4r
Ww&_Kw^V
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 obfair*g any other State, Federal, or Local
authorization.
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Any person who proceeds with a development without the con"'
on
r
sent of a LAMA official under mistaken assumption that the
Applicant's nature
development is exempted, will be in violation of the CAMA it there
!/G
/ t,
is a subsequent determination that a permit was required for the
deve-lopment..
CAMA Iciars signalurail
The applicant certifies by signing this exemption that the
5/7 /2o1 q 9 / 7�� Q
applicant will abide by the conditions of this exemption.
Issuing dale Expiration Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Applying for Permit: 1 n (,o �A n 1d:232
Mailing address: 1 l C a- ly (� CAc�7
Phone Number: q 16 - x u a- i o u?o
I certify that I have
to act on my behalf, for the purpose of applying and obtaining all CAMA permits
necessary for the proposed development of e \
at my property located at 1 4 ` (, `2 2LC A/,1 �&,Vu l�
in (�)IU., County. ITv` -" &QC�_
This certification is valid through M ayj 01 Q
D to
(Property Owner Information)
Sign re
c,
n or Typ ame
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Date
Phone Number
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Em Address

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