Jones

CERTIFICATION OF EXEMPTION
FROM REQUIRING A CAMA PERMIT ��.//�3/�
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.
licant Name 7)ON{' Phone Number
ress
State Zip
ject Location (Coupty, State Road, Water Body, etc.) /
e and imensions of Project i4e t/;-7'4�i
fr
b proposed project to be located and constructed as described
)ve is hereby certified as exempt from the CAMA permit re-
rement pursuant to 15 NCAC 7K .0203. This exemption to
MA permit requirements does not alleviate the necessity of
it obtaining any other State, Federal, or Local authorization.
This certification of exemption from requiring a CAMA F
valid for 90 days from the date of issuance. Following exl
a re-examination of the project and project site may be ne
to continue this certification.
KETCH (SCALE:
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CERTIFIED MAIL - RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
Name of Property Owner: L • D O U (`i-0+r �S V N & S-
Address of Property:
Applicant's phone #:
/9 FLORID A AVE Mgbi-IN4 /.RtAC,4
(Lot or
9/ S� -77�f -oSv6
#, Street or Road, City &
/VtW /Yft o v5
Mailing Address: Z 1 S r R y ON /R D
%ZAUE / 6-N, n/-C-
I hereby certify that I own property adjacent to the above referenced property. The individual applying for this pe.
has described to me as shown on the attached drawing the development they are proposing. A description of draw
with dimensions, must be provided with this letter.
PhI have no 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 (DC:
in writing within 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive
Wilmington, NC 28405-3845. DCM representatives can also be contacted at [phone]. No response is
considered the same as no obiection if you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, or lift must be set back a minimum distance
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' set back requirement.
I do not wish to waive the 15' set back requirement.
(Prop e Owner Inf�orm_tion)
Signature
Pq 72, ct N Iq i1`a cec
Print or Type Name
(Riparian Property Owner Information)
Signature
Print or Type Name
to�uE�51 14,4-LL L1 nl
Mailing Address
Mailing Address

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N.-Cs.
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CERTIFIED MAIL — RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
Name of Property Owner: L- D 0 U G CA S' S o MC r
Address of Property: Z J /-L OR/04 f}YS CAKO4,/h//4 IV&W HA-W0VVL.
(Lot or Street #, Street or Road, City & County)
Applicant's phone #: 9 /9— 7%q -OSO 6 Mailing Address: Zi r / ixy ON R d
RA4C-r 6-11�/ -(,.._?7 6o3
I hereby certify that I own property adjacent to the above referenced property. The individual applying for this pe
has described to me as shown on the attached drawing the development they are proposing. A description of drau
with dimensions, must be provided with this letter.
L-"" I have no 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 (DC
in writing within 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive
Wilmington, NC 28405-3845. DCM representatives can also be contacted at [phone]. 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, or lift must be set back a minimum distanc
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' set back requirement.
I do not wish to waive the 15' set back requirement.
(Property Owner Information)
(� All.
Signatu
.8 � vv pi- it
Print or type Name
Mailing Address
(Riparian Property Owner Information)
Signature
Print or Type Name
Mailing Address