Untitled (9)

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.O4 03 or NCGS 113A-103 (5) (b) (5)
Applicant Name -INOµAS roRsAA►i Phone Number N1A
Address a-141 140T -roAy ►'`-D
City C.NAR--o•r� State / 1C zip .2-r
Project Location (County, State Road, Water Body, etc.) 10 Cc / 10 r WA-rr-V ' -T
Type and Dimensions of Project
?>i:•-u Posc� �c,ylTenl[� �I.yG.� 'Dock. Q+GDLwcr�►wM
G 50 % of Fi,aA-ri VC -I P.3CIL
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.
AEC(S): +E. W ,& p-r A SCALE:
I I I 1 I I 1 1 I I I 1 I I
I I I I I I I I I 1 I I I I I
h--F--F--1---t--t--1---t--F--+---1.-c-�t--4--�jt--tf--F--i---+--t--t--+--f--t-'1jj�`�/-F--Y--�
h--Y--Y--t--t--Y--t--t--t--t--t--t--i--t--t--t--t--1--1---t--t--t--t--Y---Y--Y--Y--i
1 I I 1 I 1 1 1 1 1 I I I 1
1 I I I 1 I I I 1 k I I I I I
1'--Y--Y--t--t--Y--t--t--t--t--t--t--
-- -- -7--r-�---t--t--t--7- --t--r--r--r--�
I 1 1 I I I I I 1 1 I I
I I 1 I I 1 I I I I I I I I I
1 1 1 I I I I I I I I I
r--r--r--r--T--r--t--t--r--T--t--T--
_
1 I I 1 I I I 1 1 1 I I 1
__r--1---T--T--T--T--r--T--r--r--r--�
r--r--r--r--r--r--r--r--r--r--r--r--
--
---'
--T--r--r--r
r lTTrr?^�"ipr�Tr��--;
' c.l4s 40 "* 4'
f--r--r--r--T--r-'r--r--r--T-'r--T--
--
- ---T--r-1- T ---T--T--r--T--r--r--r--1
r--r--r--r--r--r--r--r--r--T--r--r--
--
r-�---r--r--T--T--r- r--r r r i
I 1 I I I I I I I 1 I I
I 1 I I I I I I I I 1 I
I I 1 I I 1 I I I 1 I I
f--,---r--�--T--,---,---r--,---_--,---T--
--
I I I I I 1 I I I I I 1 1 I
--T- r T--,---,---i--T--T--T--,---T--,---,---,---;
I 1 1 I I I 1 I I I I I
t--L--L--L--1--L--L--L--L--1--L--1--
I I I I I 1 I I I I I I 1 I
--1--L--1--�--�---1--1--1--1--1--1--L--�--L--J
I I I I I I 1 I I I I I I
I
I I I I I 1 1 1 1 I I I 1 1 I
I I I I I I 1 I I I I I I I
I I I I I I 1 I 1 I I I 1 I I
I I I 1 I I I I 1 I I 1 1
1 I
I I I I I I I I I I I I
I 1 1 1 I I I I I 1 I I 1
I I
I I I I I I I I I I I I
L__L__L__L__1__L__L__L__L__1__L__1__
I I I I I I I I I 1 I I I I
I
I 1 1 1 1 I I I 1 I I I
1 I I I I I I I I 1 I I I I I
I 1 1 I 1 I 1 I 1 I 1 I
1 1 I I I I I I 1 1 I I I I
I
I I I 1 I 1 I 1 I I 1 I
I I 1 I I I I 1 I I I I I I
L--L--4'--1'--�--L--1'--L--L--1--L--'1'--�--L--;--
I
--
I I 1 I 1 1 1 1 I I 1 I
--L-�---L--1--1--1--L--1--L--1-'--L--�
I I I I 1 I I 1 1 I I I I I
1
I I 1 I 1 1 I I I I I I
I I I 1 1 I I 1 1 I 1 I I I
1
I I I I I 1 I 1 I I 1 1
I I I 1 1 1 1 I 1 I 1 I 1 I
I
I 1 1 I I t 1 1 I 1 I I
I I I 1 1 I I I I I 1 1 I I
--F-- --t'--t--}--�--}----+--f'--+--i--
1
--i--
I I 1 1 I I I I I I I I
-4 --- 4--+--+--+--� ---t--E'--�--�--a
I I I I I I I I I 1 1 1 1 1
1
1 I I I I 1 1 I I 1 I I
I 1 I I I 1 I I I I 1 I I I
I
1 I I I I 1 1 I I I I I
Any person who proceeds with a development without the con-
sent of a CAMA official under mistaken assumption that the
Applica.nt's gnature
development is exempted, will be in violation of the CAMA if there
/
'Z
is a subsequent determination that a permit was required for the
development.
CAMA Official' signature 67
The applicant certifies by signing this exemption that the
applicant will abide by the conditions of this exemption.
Issuing date Expiration date
. N

N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date 1 -31
Name of Property Owner Applying for Permit:
eF►-t S i v � S'i a --
Mailing Address:
-7
I certify that I have authorized (agent) t ; CXR;� ! ' -Cr n, canto act on my
behalf, for the purpose of applying for and
++ obtaining all CAMA Permits necessary to
install or construct (activity)1
at (my property located at) l 6 1 W atnr
This certification is valid thru (date)
)4,.- --� 121IL3
Property Owner Signature Date