Gre Gick

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 � le . Lc Cam-; c Phone Number 3 1 92-6 19
Address ck CJf `.1C
City f e r..p State t J Ci Zip I O
Project Location(County, State Road, Water Body, etc.) ICJ( n ,,l s% c _ `:c,u I '7 v 4 (
Type and Dimensions of Project QkA\\C\c•sL(-d CC-1)\ -c ear * U ti C *-4-C 111 � n )
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.
SKETCH (SCALE:
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Any person who proceeds with a development without the con- /Y /11
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
development. CAMA Official's signature
I c1 o() v
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

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7_14('
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
FOR CONSTRUCTION OF A
BULKHEAD
' 11(4
1(
I hereby cert ify that I own property adjacent to (.. Q 6160 /6
�
property located at See , (C ,awl
( street address ,
on a man made canal in the Town of Holden
lot no & subdivision)
Beach. I have no objection to a BULKHEAD being constructed at this
location.
Adjacent property owner J2� 71. 11)°151.-)
Sig ature
inOtP./67ea l¢ ,1 ame (p se prfntil2 °'
type)
Adjacent property owner
Holden Beach Address
Home Address
City, State & Zip
CAMA requires property owners signatures before general
permits or exemptions are issued. CAMA's Wilmington Regional
Office address & phone number is 127 Cardinal Drive Ext . ,
Wilmington NC 28405 , ( 919) 395-3900 .