Morris

1 " CERTIFICATION OF EXEMPTION
FROM REQUIRING A CAMA PERMIT
as authorized by the State of North Carolina,
C� 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 Q�ln + No f r1 Phone Number
Address / / t ( r f L_c4 n r
City P e S ` r• State V Pr Zip 1
Project Locatio ( ounty, State Road, Water Body, etc.) ha. 5 a w,4 / ., Cree K S'gb �("„64' ),',,
No^cy1s (ret k i^ ljr.,,,k) u.., A Cc ,
Type and Dimension of Project f.c- f Ai ' X 6 0 pi(r of.i 4-L lk /6; r4"p
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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 cal autho ization.
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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 c ' signature .. .ce"/L
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 is 's natura�
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The applicant certifies by signing this exemption that (1)the ap- Issuing date r
plicant has read and will abide by the conditions of this exemp-
tion,and(2)a written statement has been obtained from adjacent -- )`
Innrinu.nnrc nn rtif.ann that 11-Io., hoao nn nhinntinne to tho C.,.....�;,... .J..,..

The American Fish Company
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P.O. Box 11046 [phone]
Southport, North Carolina 28461
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MYRTLE BEACH

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to
'-'211-1410,2-1-//717
's property located at
name)
r<or, 144,/ - on
( t, block, 7a c. )
i. in
(w ter ody) "fi
5 r/ N.C.(tow and/or cZunt �i/�� �(/��
/ Y)
He has described to me as shown below the development he is
proposing at that location and I have no objections to his
proposal. I understand that a pier must be set back a minimum
distance of 15 feet from my area of riparian access unless waived
by me. I do do no , wish to waive that setback requirement.
MEOW
Description and/or drawing of proposed development:
(To be filled in by individual proposing development. )
( gna ure)
`/t cAtet(1 S, 13 Liorr_,K
(print name)
910 - ► 5-1 - VS-10
(phone number)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to
th4,44j* � 's property located at
(name ,
' e -efr on
(lot, block, road, et.
d1/('‘• 1'7i.- in
(uater od
,4 /e l , N.C.
town n r/n t
( / n y)
He has described to me as shown below the development he is
proposing at that location and I have no objections to his
proposal. I understand that a pier must be set back a minimum
distance of 15 feet from my area of riparian access unless waived
by me. I do do not ish to waive that setback requirement.
NOIMmow-
Description and/or drawing of proposed development:
(To be filled in by individual proposing development. )
(signature)
c}/v\c,,,)d MCC c -a
(print name) /
(IN 61):6 -(q(,,t
(phone number)