Readling

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 7KSj2d3.
licant Name Phone Number"
resA
State (, Zip I 2 0
ect LocatAn (County, State Road, Water Body, etc.) t"
proposed project to be located and constructed as described This certification of exemption from requiring a CAMA pe
e is hereby certified as exempt from the CAMA permit re- valid for 90 days from the date of issuance. Following expi
�ment pursuant to 15 NCAC 7K .0203. This exemption to a re-examination of the project and project site may be necE
IA permit requirements does not'MS*ite the necessity of to continue this certification.
obtaining any other State, Federal, or Local authorization.
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FRrVC1�R
Nor n Carolina Department of Enwironment and Natural Resources
Civision of Coastal Management
Beverly Eaves Perdue Jauras H. Gregson Dee Freeman
Gcvemor Director smmtary
AGENT AUTHORIZATION FORM
Date: / L'; -,.2 4 _ f /
Nara of Property Owror Applying 'or rerml: Nar ,e of Authorized Agent for this project:
7 i C.�"1�3yj_�,•�t'.t 1 -
v
Owner's Mailing Address:
7 X� y- C. n c;�w � 4
Phone Number�t7
Agent's Mailing Address:
Phone Number
I certify that I have authorized the agent listed above to act on my behalf, for the purpose of applying
for and obtaining all CAMA Permits necessary to Install or construct the fo{lowing (activity):
( my property located) at
This certification is valid thru (cafe) r ' �
Property Own&r' Signature Date

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSBOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to �—p' _� 4 �-AL r, IS
(Name of Property Owner)
property located at 3 /3 % E� lam; ,
(Lot, Block, Road, etc.)
on in >' �` N.C.
(Waterbody) TownAnd/or County)
Applicant's phone Mailing Address:
He has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal. I understand that a pier/mooring pilings / boatlift / boathouse
must be set back a minimum distance of fifteen feet 1 ' ea of riparian access unless
waived by me. (If you wish to waive the setback' ou must initia he appropriate blank
below.)
I do not wish to waive
I do wish to waive that setback requirement.
---------------------------------------------------------------------------------------------------------
DESCRIPTION A-N-D/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
Ise -le- 0--ffaX-L) CQL,--)�
(Information for Property Owner Applying
for Permit)
----------------------------------------------------
(Riparian Property Owner Information)
_ fZ�� e
MailinL, : _duress
iionntnre

Auj I,C /
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGS/BOATLIFTBOATIIOUSE)
I hereby certify that I own property adjacent to _ )i�� 4�AL; rkc' 's
(Name of Property Oivner)
property located at Pt�
(Lot, Block, Road, etc.)
on in `� �` � , N.C.
(Waterbody) Town nd/or County)
Applicant's phone #:7 —�� 5� Mailing Address:48 : . '�' .
`j IL -VA ill c a? 7
He has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal. I understand that a pier/mooring pilings / boatlift / boathouse
must be set back a minimum distance of fifteen feetmy area of riparian access unless
waived by me. (If you wish to waive the setback' you must mitiaa he appropriate blank
below.)
I do not wish to waive
f do wish to waive that setback requirement.
DESCRIPTION A-N-D/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
(Information for Property Owner Applying
for Permit)
_=��c� �Q
Mailinv : _daress
--------- ------------------------------------------
(Riparian Property Owner Information)
ianature

Owner: Sue Readling
4136 Orpahnage Rd
Concord NC 28027
1-704-784-2745
Contractor: Richardson Construction
3232 Seacrest Ave SW
Supply NC 28462 NOT TO SCALE
[e-mail] North
910-367-0335
existing dock 23ftx28ft 158FT
ICW removing sun deck above
4 feet wide
70 FEET