Allen

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.
licant Name 26V;� /oc-, ///u , c "t Phone Number % J-E
ress �jS oedscn1-9bdL Dn.
N, / / s 6gg 6'W'6 6 State Zip Z 2s
ect Location (Co nty, State Road, Water Body, etc.) y�- 7
C p'& OCO�i J 1S' L�. �p/iC . 2.�.rtc✓�c�C Ca...� ��
and /Dimensions of Project geevyve�� %/� // vim,.✓
�/1d�P(`� Th2CAi i,.ilr/ S�Aur1u,[ G
)roposed project to be located and constructed as described
e is hereby certified as exempt from the CAMA permit re-
,ment pursuant to 15 NCAC 7K .0203. This exemption to
A permit requirements does not alleviate the necessity of
obtaining any other State, Federal, or Local authorization.
This certification of exemption from requiring a CAMA pe
valid for 90 days from the date of issuance. Following expii
a re-examination of the project and project site may be necE
to continue this certification.
ETCH (SCALE: G U
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�CAMA / 'DREDGE & FILL
1'rENERAL PERMIT Previous permit#
New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
•ized by the State of North Carolina, Department of Environment and Natural Resources r�
:oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC J /,z,*(�'
+[�RGfes attached.
t Name Project Location: County ?k -V t
Street Address/ State Road/ Lot #(s)
1
-_1 54 4-_ 2 a State /%/G ZIP 2 2 7
c_
(�) Fax # () Subdivision
ed Agent
❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS
K�QEA �HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS: ❑ FC:
City t ZIP
Phone # () River Basin
Adj. Wtr. Body A/LA�'1•G QC,osJ,.i�/n
yes /Pno'. PNA yes Crit. Hab. yes / no
Closest Maj. Wtr. Body ��" �Gr.�✓
Project/ Activity 6 01'O.d G OA1 c-517--1 d iAl e, O.T d ec)
(Scale:1
:k) length , 1 _
I
r —r -.
igth
nber
I/ Riprap length_
distance offshore-
( distance offshore
annel
is yards_
'P
,e/ Boatlift
11dozing
Length 50
notsure yes V.
not sure yes'
im: n/a yes
0 ,no
ttached: yes G—
g permit may be required by: Ung sf,...yr ,*it f� ""g-C !j ❑ See note on back regarding River Basin

'22/2009 16:56 910-579-9353 COOKE REALTY PAGE 01
One Causeway Delve
Ocean We Beach, NC 2W9
(910) 5793535
[phone] fax
m ww,ccokerealty.00m
Cooke
Realty
E ` W 15 0 la From: C,
Fax: "{ p 19 `_t!P S g L,4 Pages:
Phone; 2 1 2 - A/ 2- 3 Q 9- 7 `j Date: I'7 - I Z -- V. -)
Re: Cc:
❑ Urgent ❑ For R4wiew ❑ Please Comment 0 Please Reply ❑ Please Recycle
��ti�s

'22/2009 1G:56 910-579-9353 COOKE REALTY PAGE 02
TO WHOM IT MAY CONCERN:
V
I, -7vm x>d 14-
1LRPea FcS 4A-cr
give permission to
to act as
my agent in my behalf in obtaining a CAMA General Pen -nit to place
sandbags as a temporary erosion control structure in front of my
property at s7zr CVj 5
I,
have r. ead the
specifications in 1 SA NCAC 7H-1700 and understand that the sand
bags may remain in place for up to years after the date of
permit approval. I understand that I will be responsible for removing
the sandbags within 30 days after that period or at any time that they are
determined by DCM staff or its agent to be unnecessary due to
relocation or removal of the structure. I will also be responsible for
.removing any damaged sandbags during the period they are authorized
to be in place.
I also understand that the removal of the sandbags shall not be
required if at the specified date for removal they are determined by
DCM staff to be covered by dunes with vegetation sufficient to be
considered stable and natural.
AUTHORIZED SIGNATURE: '✓
DATE: '/ - -z - 0 ?

22/2009 16:56 910-579-9353 COOKE REALTY
Z , NCDENR
North Carolina Departmentof Environment and Natural Resources
Division of Coastal Management
Michael F. Essiey, Governor James H. Gregson, Director .
Authorized Agent Consent Agreement
PAGE 03
William G. Ross Jr., S
4 IL Ec t �� is hereby authorized to act an my bet
erred Name of Agent)
in order to obtain any CANNA permit(s) required for the property listed below. The authoritation is limited ti
specific activities described in the attached sketch.
LOCATION OF' PROJECT:
PROPERTY OWNER MAILING ADDRESS:
_PHONE NO.� Z
AUTHORIZEDAGENT MAILING AEDRESS:
�/
T4vl / n.1Z
PHONE NO. 7S 2 `i—1 qi
Signature of Property Owner:
Signature of Authorized Aaent: 1'\ -- .

'22/2009 16:56
910-579-9353
CDOKE REALTY
PAGE 04
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