Holland (3)

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.
Applicant Name C-fiieit` ( /-,0//44'y} '�r'� / f' 4 Mr11 Phone Number'9/'i ) 6 6 a-2
Address dv IMO') i ''
City 9 Meet- State Zip ,) 7 5`.
Project Locatio (County, State Road, Water Body, etc.) t/07 7 c�� 5� . j N
N tN /tea ti - /114 Gf c.4 Z Dom-s/0w Co -
Type and Dimensions of Project _f/ o . ��fil��J 33H/,'iU4')
4-v6-60-
-1E C 70kvic- SO,F Ci74/_ iQ /3/4;i4/±/ �"Iiein . �- /1
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The proposed project to be located erhd constructed as described This certification of exemption from requiring a CAMA permit is
above is hereby certified as exempt from the CAMA permit re- valid for 90 days from the date of issuance. Following expiration,
quirement pursuant to 15 NCAC 7K .0203. This exemption to a re-examination of the project and project site may be necessary
CAMA permit requirements does not alleviate the necessity of to continue this certification.
your obtaining any other State, Federal, or Local authorization.
SKETCH (SCALE: //' ) U r )
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Any person who proceeds with a development without the con-
sent of a CAMA official under the mistaken assumption that the pplicant's signature
development is exempted,will be in violation of the CAMA if there
is a subsequent determination that a permit was required for the
development. C ffiiciial'ssJsignatur
The applicant certifies by signing this exemption that (1)the ap-
Issuing date
plicant has read and will abide by the conditions of this exemp-
tion,and(2)a written statement has been obtained from adjacent 7' Y—
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yJQ C��.� VANCE E.KEE.MAYOR
NELVA R.ALBURY.MAYOR PRO TEM
4
URF CITY KENNETH D.BATTS,couNCIL IaEMBER
ti DOUGLAS C.MEDLIN-couNCIL MEMBER
� -c--�� BOBBY C.SMITH,COUNCIL MEMBER
Off. L LP- TODD N.THOMAS.COUNCIL MEMBER
NORSH NORTH CAROLINA 28445 _
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION
Applicant's Name: IA/22y a ZZA- ✓e
Address Of Property:
Street#, Street Name, City & County
Applicant's Telephone Number
I hereby certify that I own waterfront property adjacent to the above-referenced property. The
applicant has provided me a drawing of the the proposed development. Please initial the
statement below if you have no objections to the applicant's proposed development. Initialling
this block does not constitute a waiver of the required 15'setback from the riparian corridor
lines.
I have no objections to this proposal.
Signa r Date
FA y /4. Wee-i.<s $ os $ 16,r, Alc A w ' ' AL 28 3 3 7`
Print Name and Mailing Address
Telephone Number With Area Code
If you have objections to the applicant's proposal, do not initial or sign this form. You should
contact the Local CAMA Permit Officer listed below as soon as possible to register your
concerns:
Telephone:
kr ....__^ `-• °`r s z."...`.�,s 'a�0 ��Y ; °w, '-ak�4Tvtee' <s��...a"..,+,
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