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CERTIFICATION OF EXEMPTION
FROM REQUIRING A CAMA PERMIT
as authorized by the State of North Carolina,
0 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 fl la ( o i-- I` A t i ES'�19 Phone Number 10 Li 5 cu-)" .O
Address P C) --elo X 2 1 5
4
City C )\ p.c. I014K State fJC.1 Zip c L 22q -
Project Location (County, State Road, Water Body, etc.) 'bra f\St.,,,)',C V._ C Q u.n�1 1 4-4t- Ste_`CriS
o�c C 3 rr-'G+ C 1 c ep-N Sc 1�J i .-A r�k, k ram,- l\4 nd c_ C�i,�A j
Type and Dimensions of Project ICE' X 10' F Ic,Pv{-, n -Doc K•
- outer edctei oe f lu6+ rnus-t n t exec-eel o'to'? ' cro.r, InIrick- h'►c1I^
-it-,,de 1.,n r j o r, -4'1,,,ai b u t IL hem
c no 4- !musk- hem 01) Ic.-is+ I,- ' z) ' of f ', QA�',e L`knvon eAcLN 5'�C
The proposed project to be located a d 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 l d - ,�- F,
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. -AThr 0•
CA ici I's signature
The applicant certifies bysigning this exemption that (1)the a —Issuing crt ' f Cwv
pp g g p p Issuing ate
plicant has read and will abide by the conditions of this exemp-
tion,and(2)a written statement has been obtained from adjacent I ) 0.00 0
lanrinwnarc rartifvinn that thou Nava nn nhiartinnc to tha c....;...+;....A.,...

SION OF COASTAr Nr�NAGE ,T
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION
Applicant's Name: /1 /2 s. /-JAce&V . 46' vcc" -7 ,rec z 74=
Address Of Property: /(-/3 E. 2 A/,). S 7--- C 4-0 A) / /3& 9 e;; , C
Street#, Street Name, City & County
Applicant's Telephone Number %t V 94 3 2 2 0
I hereby certify that I own waterfront property adjacent to the above-referenced property.applicant has provided m dmu�n.. P PAY• The.��.,g of the the proposed development. Please initial the
statement below if you have no objections to the applicznt's proposed development. Initialling
this block does not constitute a waiver of the required IS'setback from the riparian corridor
lines.
I have no objections to this ro osal
P P -
Si e 0
Die /
//i i)r
Print Name and Mailing Address 'I J J� Q
A r ; ,).a Ziff
Telephone Number With Area Code
m, dhl bone rn , < / 4? /toH j -
t. l p d4Gi
If you have objections to the applicant's proposal/ o not �'tiaiai orsign� this form.e tic ' 5 '� c
contact the Local CAMA Permit Officer listed below as soon as possible to register You
concerns ��"`°�
Peggy K. Pelasara ` a b le >J e�-
��PSf Thi rr� ¢r J l
Ocean Isle Beach, NC 28469 ATOfh2' % �`^d doe
Telephone: 910-- 7 9-70 70

ION OF COASTA T Me NA r-EMEN►r
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION
Applicant's Name: .B4l/4 'n? /247:44 rar
Address Of Property: /�3 ,�; L Vs' s r.. eie is /3L 44-4e/i N. e, ,d ev,�s,rr.cK
Street#, Street Name, City & County
Applicant's Telephone Number 70 Sy4 3 Z L
I hereby certify that I own waterfront property adjacent to the above-referenced property.
applicant has provided me a drawing of the the proposed development. Please initial the 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.
k 1, -
Si e �4
/-9,��/vc Date
20c' /DOT;5 /32 �/NCif T2.f>, �%2.9NK[/i✓, /V G, Z g 73 .1
Print Name and Mailing Address
' fo 3- 79 - 8ezi
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:
Peggy K. Pelasara
1,1PGt Third St.
Ocean Isle Beach, NC 28469
Telephone: [phone]