Wilkinson

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CERTIFICATION OF EXEMPTION
FROM REQUIRING A CAMA PERMIT
as authorized by the State of North Carolina,
0 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 wiik/AS6''' Phone Number `40/77c-32)
Address Ittor IIOre z7336
City ,, , State , ie Zip 2
Project Location(County, tate Road,Wat Bod , etc.)
ANA `
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Type and Dimensions of Project /to kw A,.7 exis.A:,l dilai f /.'7-f:
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 Local authorization.
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Any person who proceeds with a development without the con- Lk
sent of a CAMA official under the mistaken assumption that the App!cant' signature
development is exempted,will be in violation of the CAMA if there (�/J// `
is a subsequent determination that a permit was required for the t �-,,t,.
development. CAMA Offiiccial's signature
The applicant certifies by signing this exemption that (1)the ap- ��` S/�l
Issuing date
plicant has read and will abide by the conditions of this exemp4
tion,and(2)a written statement has been obtained from adjacent 7115IP
landowners certifying that they have no objections to the Expiration date
proposed work.
Attachment: 15 North Carolina Administrative Code 7K.0203

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Individual Applying For Permit: % Wt r//t rAf fo�l
Address of Property: /O/ 4 4444 ,41 LI V
(Lot or Street#, Street or Road) /
(City and Co ty)
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 description or drawing, with dimensions, should be provided with this letter.
2- e4.04 oto ca my Cxisf..s f_,(sa,t-f Lift oc¢.f if fa C.Oeet Ara ,.r c
- I/ � * i J(i ;n5[ PLe. Wu Di";10" c�,
, I 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 910-395-3900
within 10 days of receipt of this 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, boat house or boat lift must be
set bck 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.)
41/
I do wish to e waiv the '15 setback requirement. __._ _ -- _
I do not wish to waive the 15' setback requirement.
41 (X\ � 1 1 s
Sign ame Da e
Hai Elzcbe. AtMA
Print Name
qt. q -- eecti = 11 NCDENR
qv 0 2 , 8 �g NORTH CAROUNA DEPARTMENT OF
rJ /� 1 ENVIRONMENT AND NRURAL RESOURCES
Telephone Number with Area Code
S:\cama\shells\riparianproperty.frm

. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Individual Applying For Permit: Doug Wilkinson
Address of Property: 101 Bland Alley
(Lot or Street#, Street or Road)
Surf City, Pender
(City and County)
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 description or drawing, with dimensions, should be provided with this letter.
I am seeking to move my existing boat lift out 4 to 6 feet, no farther than the
existing floating dock/have no objections to this proposal.
` 1
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 910-395-3900
within 10 days of receipt of this 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, boat house or boat lift must be
set bck 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.
? 3/ b 3
Sign ame Date
7El7 ( ) C CC- 4617,A
Print Name —
9/0 - 3�� - 6 � NCDENR
EMv1R01.ICM AND NutNaxuRAL R£SDURCes
Telephone Number with Area Code
S:\cama\shells\riparianproperty.frm

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