01737D - Schwaiger

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• CERTIFICATE OF EXEMPTION 15,
FROM REQUIRING A LAMA PERMIT
as authorized by the State of North Carolina,
Department of Environment and Natural Resources and the Coastal Resources Commission
in an_arq of enA pmental concern pursuant to 15 NCAC Subchapter 7K __ ,
Acant Name v
Tres
e r�
ject Location (County, State Road, Water Body, etc.)
>e and Dimensions of Project
proposed project to be located and constructed as described
e is hereby certified as exempt from e CAMA permit
rement pursuant to 15 NCAC 7K 1 0� . This exemption
,kMA permit requirements does not alleviate the necessity of
obtaining other State, Federal or Local authorization.
011
This certification of exemption from requiring a CAMA p,
valid for 90 days from the date of issuance. Following exp
a re-examinatlon of the project and project site may be ne
to continue this certification.
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CDERIP
North Carolina Department of Environment and Natural Resources
Division of Coastal Managemen - — --
Pat McCrory Braxton C. Davis John E. Skvarla,
Govemr Director Secretary
AG FORM
Date: ^ -
me of Prop Owner Applying for Permit:
Owner's Mailing Address
:!� :
Phone Number 1 C , •.
Name of thorized ent for is p
Agent's �illl
g Address:
C-a
Phone Number�a) (p
I certify that I have authorized the agent listed above to act on my behalf, for the purpose of applying
and obtaining all CAMA Permits necessary to install or construct the following (activity):
For my property located at
This certification is valid thru (date)
7 IJ
Property Own Signature Date

T-d do t 'E cCA
ENT
( hereby certify that 1 own property adjacent to
property located at` is t r 10, C l 1 n
(��
on C..aC'�.`"T�� Jt1tC4C (Address,
, in
(Waterbody) wa-kez w ��
C,k VJ c t- t 's
) of Premuty Own L
etc.)
(City/Town and/or County)
N.C.
The applicant has described to me, as shown below, the development proposed at the above location,
!� I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
WAIVER SECTION
i understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set back a
minimum distance of 15' from my area of riparian access unless waived by me. (If you wish to waive
the setback, you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Proppeerrtyy Owner I formation) (Adjacent Property Owner Information)
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,a
ature _ - Signature-e
Print or Type Name Print or Type Name
Aln;inr A,4,4r ems'\ ♦ t _ AA'—W— A.drlr—

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPEICY OWNER NOTIFICATION/WAIVER FORM
`� , L 11 I
Name of Property Owner:
Address of property:
(Lot or Street *, Street or Road,
Agent's Name #:
Agent's phone #:
Mailing Address:
I hereby certify that I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing the development
they are proposing. A descri tion or drawin with dimensions must be provided with this letter,
I have uo objections to this proposal. _ I have objections to this proposal.
If you have objections to what is being proposed, you must notify the Division of Coastal Management (DCM) In
writing within 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive Fart.,
Mimington, NC, 28405-3845. DCM representatives can also be contacted at (W) 796.7215. No response is
considered the some as no ob ectlon if You have been notified bE Certified Mall.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set
back a minimum distance of 15' from my area of riparian access unless waived by me, (If you
wish to waive the setback, you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Prop Owner Inf rmation)
s
Signature
�-
Print or Type Name
I P�(,yin
Mailing Address 1
(Adjacent Property Owner Information)
Signature
Zsre o� VJ�im.Q ISSLa
Print or Type Name
Mailing Address

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