Gray

CERTIFICATION OF EXEMPTION
FROM REQUIRING A CAMA PERMIT
as authorized by the State of North Carolina,
Department of Environmental Quality and the Coastal Resources gommission in an area of
environmental concern pursuant to 15 NCAC Subchapter 7K Lilt r NCGS 113A-103 (5) (b) (5)
Iplicant Name G h V7 b< (. I1; ", KA
dress V1 ii S iJ o 11-VA (1.1v1 i'G'Ir C
Phone Number lJ6
ry IL-1 State N zip
ojp; Location (County, State Road,
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proposed project to be located and constructed as This certification of exemption from requiring a CAMA p
Abed above is hereby certified as exempt from the is valid for 120 days from the date of issuance. Following
IA permit requirements. This exemption to CAMA expiration, a re-examination of the project and project site
lit requirements does not alleviate the necessity of be necessary to continue this certification.
obtaining any other State, Federal, or Local
Drization
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NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Pat McCrory Braxton C. Davis John E. Skvada
Governor Director Secretary
AGENT AUTHORIZATION FORM AGENT AUTHORIZATION FuKm
Date: MARCH 15, 2017
flame of Property Owner Applying for Permit: Name of Authorized Agent for this project:
JOHN & CONNIE GRAY
)wner's Mailing Address:
_4852 NORTH CENTER ST
HICKORY NC 28601
'hone Number 8( 28) 302-9817,
GRICE CONSTRUCTION
Agent's Mailing Address:
_6618 BEACH DRIVE SW
OCEAN ISLE NC 28469
Phone Number(.
certify that I have authorized the agent listed above to act on my behalf, for the purpose of applying
or and obtaining all CAMA Permits necessary to install or construct the following (activity):
Dig out bulkhead and pull over. Furnish and install 13 new deadmen. Furnish and ins
)ost on dock and support deck. Extend ramp Into deck.
'or my property located at _143 DOLPHIN DR., HOLDEN BEACH_28462
'his certification is valid thru (date)
,MARCH 15, 2017
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