Jones (3)

CERTIFICATION OF EXEMPTION
Tr-) FROM REQUIRING A CAMA PERMIT
GPS 5,=.y 33/V C
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 3 MJ\(' 3o►Jee7 Phone Number 91`f 5co' Io4
ress a 11 S L,►,t(c LL-N
CVNYTo^' State /l.C' Zip
ect Location(County, State Road, Water Body, etc.) 'w S�b 4I?Fee,' AAA-- "Ai
t4/-t_.
e and Dimensions of Project 4-.4,4 l/' X/6' Covet "7v t k0 &` DocK-- o ''f c 'A I •
t /i i i, rood' Area Sc44it c xio4-cr ov.P! r ,-I;�1 jrcAA ?or fir•-•
proposed project to be located and constructed as described This certification of exemption from requiring a CAMA pE
ie is hereby certified as exempt from the CAMA permit re- valid for 90 days from the date of issuance. Following exp
Dment pursuant to 15 NCAC 7K .0203. This exemption to a re-examination of the project and project site may be nec
IA permit requirements does not alleviate the necessity of to continue this certification.
obtaining any other State, Federal, or Local authorization.
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DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
ne of Individual Applying. For Permit: -Attl ;ce e 5
iress of Property: —7(? S(Q $1
(Lot or Street#, Street or Road)
5urF Cf
(Cit
y,y and County)
reby certify that I own property adjacent to the above-referenced property. The individual
Lying.for this permit has described to me as shown on the attached drawing.the development they
proposing.. A descri.tion or drawing, with dimensions, should be provided with this letter.
',1 _ I have no objections to this proposal.
ou have objections to what is being proposed, please write the Division of Coastal
nagement, 127 Cardinal Drive Extension, Wilmington, NC 28405 or call 910-395-3900
iin 10 days of receipt of this notice. No response is considered the same as no objection if
have been notified by Certified Mail.
WAIVER SECTION
derstand that a pier, dock, mooring pilings, breakwater, boat house or boat lift must be
Ick a minimum distance of 15' from my area of riparian access - unless waived by me. (If
wish to wave the setback, you must initial the appropriate blank 1 Flow.)
i Fy L,- ,4ilia Aid 04 ee e.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
, x 07/0!
Name Date
i 7 /,-,

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NO 111-ICATION/WAIVER FORM
ne of Individual Applying For Permit: D 1 '
cress of Property: 7 ) > — S
(Lot or Street #, Street or Road)
(City and County)
reby certify that I own property adjacent to the above-referenced property. The individual
Lying for this permit has described to me as shown on the attached drawing the development they
proposing. A description or drawing., with dimensions, should be provided with this letter.
I have no objections to this proposal.
ou have objections to what is being proposed, please write the Division of Coastal
lagement, 127 Cardinal Drive Extension, Wilmington, NC 28405 or call 910-395-3900
►in 10 days of receipt of this notice. No response is considered the same as no objection if
have been notified by Certified Mail.
WAIVER SECTION
derstand that a pier, dock, mooring pilings, breakwater, boat house or boat lift must be
)ck a minimum distance of 15' from my area of riparian access - unless waived by me. (If
wish to waive the setback, you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement. eA-L' }----t-9-41
I do not wish to waive the 15' setback requirement.
1 Name Date
AM A