Dr. Franklin Clark

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.01 vi or NCGS 113A-103 (5) (b) (5)
ApplicantName VR-• 'RANKL�1nJ (f`-.Acxvc- Phone Number(310-Jcl"OQ44
Address 505 F'oV-JIITNE c5-r ;
City FAyI-T-TEJ1"-r- State A/C Zip 2-8s0
Project Location (County, State Road, Water Body, etc.)' W.A �F-- ¢
Type and Dimensions of Project ,
�t�PLJ►C� 4- /2 X .2-% V-usA-rrer
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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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.
Expiration Date
vlLik

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit:'
�s A` Mailing Address: fUS �(� rj
Phone Number:
Email Address: C 56*aUtp ems, ( ,�yIL�N�.�/-�'+
I certify that I have authorized CGS )1 nA
I— Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: /�61
8ve'a 1),64,(q, '-�' `
at my prop e located at cVt
in Esw County.
I furthermore certify that 1 am authorized to grant, and do in fact grant permission to
Division of Coastal Management staff, the Local Permit Officer and their agents to enter
on the aforementioned lands in connection with evaluating information related to this
permit application.
Property Owner Information:
t
Signature v
Print or Type Name
Title
Date
RECEIVED
This certification is valid through a I /Y / �[ FEB 14 M';;
QCM WILMINGTON, NC

Dr. Franklin Clark, 210 Water St., Wrightsville Beach, N. C. 28480
Replace damaged 4.5'K26floating dock section at existing pier
SOONER
V.4
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FaS Marine Contractors, Inc.
Complete Marine Construction Services
For Over 40 years!
CAPT. ED FLYNN DURWOOD SYKES
Piers, Floating Docks, Pilings, Bulkheads,
Boat Lifts, House Pilings, Repairs
P.O. Box 868 Phone/Fax: [phone]
Wrightsville Beach, NC 28480 email: [e-mail]
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