Jenkins

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CERTIFICATION OF EXEMPTION v 2 0 2000
H. _.....sic FROM REQUIRING A CAMA PERMIT
(---- 62
\ as authorized by the State of North Carolina,
Department of Environment, Health, and Natural Resources and the Coastal Resources Commission
in an area of enviro ental concern pursuant to 15 NCAC Subchapter 7K .0203.
Applicant Name J t M K ti n Phone Number
Address .�33 U i-Uf e St lil\
City ti r> r 4 h ._ t I L. o t u State i\JdJ Zip d reiC,G -7
Project Location (County,State Road, Water Body,etc.) C u r\S)s 51Ci( u_n'1"1 i 7 Ce
Type and Dimensions of Project A r ---- \ , rv,‘C.-e-d-
1\ 5 CA .47P,, 1 nI u le 50' Lam-
The proposed project to be located and 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.
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Any person who proceeds with a development without the con- ,i4-1� ; I ,..
sent of a CAMA official under the mistaken assumption that the Applicant'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 .0. '-ir)r 12)41--4<1-52----0:2—'
development. CAM Official's signature
The applicant certifies by signing this exemption that (1)the ap- v ` i ppU
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 F--Q,�Q 17 1 2-CO 1
n r ,Inr,-4u,,orc rortifvinn that thou havo nn nhiortinns to tha Fv ir,tinn d,,to

10/05/2000 14: 18 9108671030 MORGANTON ROAD ELEM PAGE 02
10/83/2000 .:23 3193a79806 GREG HOLDEN PAGE 02
ADJACENT RIPARIAN pROPIRTY OWNZR STATEMENT
?OR CONSTRUCTION or A
9ULKHEAD
I hereby certify that I own property sdlacent to 00NA 7Te ,, ,L>
property located at cC c
J ( street address,
(`'"''�"n`� on a man made canal in the Town of Holder,
lot no 4 sub iv1ston)
Busch . I have no objection to a BULI<HZAD being constructed at this
location.
Ad3ac,nt property owner
Si atur
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Name (please print or type)
Ad.lacent property owner 17 & er1 ,&'O
kp f Holden Beach Address
lJ 1�orc r� dam_
Home Addre
1vc a30
Clt , State Z
CAMA requires property owners signatures before general
permits or exemptions are issued. CAMA' s Wilmington Regional
Office address & phone number Ls 127 Cardinal Drive pxt . ,
Wilmington NC 28405, ( 919) 395-3900 .
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