Bilbro

CERTIFICATION OF EXEMPTION
FROM REQUIRING A CAMA PERMIT
as authorized by the State of North Carolina,
Department of Environment, Health, and Natural Resources and the Coastal Resources Commission
in an area of environmental concern pursuant to 15 NCAC Subchapter 7K .0203.
will giant Name , �; �, j� Phone Number (. Z31.
:ss L "L vat✓fit
.. ►_ State IQ Zip_ aZ
(County,
and Dimensions of Project
Water Body, etc.)
,roposed project to be located and constructed as described
is hereby certified as exempt from the CAMA permit re-
ment pursuant to 15 NCAC 7K .020�This exemption to
A permit requirements does not atleviafe the necessity of
obtaining any other State, Federal, or Local authorization.
This certification of exemption from requiring a CAMA per
valid for 900Ys from the date of issuance. Following expir
a re-examination of the project and project site may be nece
to continue this certification.
=TCH (SCALE:
Wyk
r N0 �►� �� WGYLK. i�
A�1�t�z►�:t>
DIST.�—
t4l^ I
e,0
I

: BB
PHONE NO. 910 e42 6954 Jan. 31 2012 11:42AM P1
fiov cU 2011 10:t1l;firl i.lr,lcy IiPwt+tr. I'.nn;Grur.t inn 810 tii+i: )171 P ;t
bLo„s Duly
AD-JACENT RIPARIAN PROVERTX OWNL, R STATFVILVT
zo s.
1 hereby cnttify thzt 1 own ptoPcrty +d�nonn'- W w .-.�—
(Namt:ofProperty ptvnc'r)
property k,eau d at
(1,nt, Block, Road, tc.)
•�� l�l , in ._�'- �IeN ��� , N.C.
on '- (Town ?nd/or County)
(Watet•body)
// HAD r1allUt Addrevo:_,� LN
APPjicant's phono M;G� I S : r�.W l�lC Z7I�L
l-lc has dest-ribul to ine, as shown below, the development 'no is lxoposiiig at that location, ond, l
hove no object ions to his proposal.
......-_..- ............... ......................
.DESCRIP•T'ION AND/OR ID PAWING 01"PROF OS&n DEVELOPMF,NT.
(To be fUled In by property umnerproposiKg dev40p?tent)
Sei fi Lsl 11
(�epAi a �x��beGl t"Art rt.,,/1 %1
S�rrn . njet1 �►� �t I c
i
.................................................
(Information for Pro(Wty owner Applying (16pariAa Pr rty O��•ne aformation)
for Pcrnl'tt)
v-07-9 Address 6igrtature
} f� c/ PQ` ant or Type NAM
QV
City/St Ztp l I I� qL t
. i
Telepi 9TlumbcT ,�•����
Telephone Number i
r 3�
Date
10
trna.<<t c��tc 5 S
L IS
ec.�rr�•-, 1\1G

rlov ill j:0 I I I CI : 061IN R i mk!j I leuietr Canstrur.t ten -q J O-B-1 2- ?117 1 p.
khL-j - IWjvw
.01JAC-ENT RIPARIAN PROPERTY oWNE, R STATRINIE NT
I ht:vcby certify that I ovAi probery lcljnmn-- to �j "C)rk- - I B (zo.
(Nurse or Property Owner)
preperty Incatud at tI k —') +
(Lnt, Blnciq Road,'(-tc�)
an -5c Li in -y)
(Watri-body) (Town -and/or Count:
L
AIIC 77,eqI-
i-lcbas dr-scAht-A to ine, is sbawn below, the development be js'propEmijig atiFej location, and, I
hnva no objections to his prripo saL
DESCRIPTION AND/OR 1) P-kWING OF PROPOSED DEVELOPMENT:
(To befillcdbt kyFraparo- viviecrproposing d2vek)pmeni)
lZepq )(7- ex.
A 19
(InforninUun for Pebparty OwnerAppMng r (RipariatA Property Owner Inronnattan)
Ior rcrmw
Mulling Addr4ns Signature
Print or Type Name
C.
Tetep�.110' u bcr Telcoh Nu ber
07co
7,
Dale
Date

North Carolina Department of En'Aronment and Natural Respurcm
Division of coasW Maniagement
Due
jwws H. . Gm9soh Freeman
Beverty Eaves Perdue James
Governor Director
AGENT AUTHORIZATION FORM
Date:
Name of Property OwnOr APPYng for Permit Name of Authorized A ntfor this Project:
W"IL'An
0,,r4fw.s MaIring Address: Maifing Address'
g /0(/
cgwz
Phone Number
PN r
I certify that I have authorized ZthO27 abcowe,It
o ad on my b". for the purpose of applying