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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 tor kro ef1f cS Phone Number
Address rb , ec City k �> State t J C- Zip X LY 3—1
Project Location(Cou , State Road, Water Body, etc.) .' P-� n th qn- i a ct e
bk ( iis '5r� nswr n
Type_and Dimensions of Project
l/i(, n r L t `j D //.i p __ -k '� Q �l K A C� ,� j�- 4 1 A-Gr
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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: N24-
" 27.
t' d I- KV (-7 (if
Any person who proceeds with a development without the con / �6-'24.,vea4-f/, 41
sent of a CAMA official under the mistaken assumption that the Applican signature
development is exempted,will be in violation of the CAMA if there n
C— ICti(1
is a subsequent determination that a permit was required for the l�' - .
development. CAMA iciaP ignature
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- 6 _ /
/
tion,and(2)a written statement has been obtained from adjacent /

03/11/1999 14:37 9108429806 GREG HOLDEN PAGE 03
.r
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT •
FOR CONSTRUCTION OF A
auLKHEAD
I hereby certify that I own property adjacent to Of Lei Qo c Iv}.cS s S
property located at / Q 4' /0 'r f� df b' S I-
( street add ems,
on a man made canal in the Town of Holden
lot no & subdivision)
Beach. I have rio of ject ion to a BULKHEAD being Constructed at this
location.
Adjacent property owner
SiOnatur e
pd A . icy
Name (please print or 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 .

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