01734D - Twin

CERTIFICATE OF EXEMPTION
'~ FROM REQUIRING A CAMA PERMIT 014.
as authorized by the State of North Carolina,
Department of Environment and Natural Resources and the Coastal Resources Commission
in an area of environmental concern pursuant tC�� CAC
in r 7K • 44U?lfi �O�
Phone Number
;ant Name 5-2
;SS , A State t` / _ Zip
ct Location ( ountx, State Road,PPer Body, etc.)
-oposed project to be located and constructed as described
is hereby certified as exempt from the CAMA permit
ement pursuant to 15 NCAC 7K . e,Yh 7. This exemption
MA permit requirements does not alleviate the necessity of
)btaining other State, Federal or Local authorization.
ETCH
4) � 5 , ) /"N--
This certification of exemption from requiring a CAMA pei
valid for 90 days from the date of issuance. Following expir
a re-examination of the project and project site may be nec
to continue this certification.
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CERTIFIED MAIL — RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER
FORM _
Name of individual applying for the permit. 01 Q V`'R
Address of ro 2 y a 5° .property-
(Lot or screen, strmt of road)
(CRY a Comfy) -
I hereby certify the 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 description or drawing, with
dimensions, should be provided whit this letter.
L�- 4:WI have no objections to this proposal
If you have objections to what is being proposed, please write the Division of Coastal
Management, 127 Cardinal Drive Extension, Wilmington, NC 28405 or call (910)
796-7215 within (10) days of receipt of the notice. No response is considered the
same as no objection if you have been notified by Certified MaiL
Waiver Section
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift or
sandbags 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_)
`- 1 do wish to waive the 15' setback requirement
WI iiv is 4" J� "1 'L C J�..LIIack, 1 cquil ✓mums
Signature late