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Home My WebLink AboutSheet CERTIFICATION OF EXEMPTION FROM REQUIRING A CAMA PERMIT as authorized by the State of North Carolina, Department of Environmental Quality and the Coastal Resources Commission in an area of environmental concern pursuant to 15 NCAC Subchapter 7K; 0- CGS 113A-103(5)(b)(5) . Applicant Name _A lir/«-- s ��r�-�( Pp Phone Number 1�� / 3-3( 9 Address X ; City //4 4A� State NC-- Zip��/ Project Location(County,State Road,,aN ft�r Body,(9tc.) IP65/6 & .,...-' -7- - ,6t//74"--- C'fft: Type and Dimensions of Project The proposed project to be located and constructed as This certification of exemption from requiring a CAMA permit described above is hereby certified as exempt from the is valid for 120 days from the date of issuance. Following CAMA permit requirements.This exemption to CAMA expiration,a re-examination of the project and project site may permit requirements does not alleviate the necessity of be necessary to continue this certification. your obtaining any other State, Federal, or Local authorization. r i el AEC S : fe. 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C A ffici s signature � The applicant certifies by signing this exemption that the / -/ 7Ze / -1 � ',I,f applicant will abide by the conditions of this exemption. Issuindate Expiration Date 1 ADJACENT RIPARIAN P Cx _� ,y5. -S7ATEVEI.117 I hereby certify that I own property adjacent to 1 f Mir,.e-e- Sii"-- ,s property located at .661 e, .57 (Name of Property Owner) (AMd;ess, Lot, Bloch, Road atc,) — or 4 ,• etr tr 4k Z_k.. ,_.e (Waterbody) (Cityrr,wn and/or County) The applicant has described to me, as shown below, the development proposed at the above location. X l hasten, to oTai. I have objections to this proposal. DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT (Individual proposing development mist ff in descripeori below or arch a site drawing) , cp /IIt- - SeptA,4t) See:-;o,) 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 wait the 15'setback requirement ii, I do not wish to waive the 15' setback requirement. (Property Owner Ir fsan ton) (Adia 'cent rope Owner info anon! Le.-&-,,, ----L--;2._.--,-/ Si gii7 --- ignature »e_�S4e_e�s St v 469 L. C44e s A) P nt or Type Name Print of Tyoe Nam /5 71 0-l/�� s 3's` C, �' a/e-rr- ,c---y) Meiling }Lr!-,ice, e hi /7 ��d35% �x�j, ass City/ p iZ M// C .2 7 S/7 7te/Zi/r „ 7/23 ` 31 5� City/Sfate/Zip 7/9- 7,2- P-O.-2 Telephone N m,er Telephone Nu r y D .> / 1. 1 f (Revised 6/18/2012) AGENT AUTHORIZATION FOR CAMA PERWIIT APPLICATION • Name of Property Owner Requesting Permit: fhr4!i1zee 'e yL,� Mailing Address: 7/ c7 /9k t)c,I t 1?6-P 1yd} 2s(3 / Phone Number: 9'/z —3�s 3- 731 Email Address: Cel4kry certify that I have authorized Agent/Contractor to act on my behalf, for the purpose of applying for and obtaining all CAMA permits necessary for the following proposed development:. at my property located at (L gl S 4 f . - L`4 r in 1)-V251 County. I furthermore certify that I am authorized to grant, and do in fact grant permission to Division of Coastal Management staff, the Local Permit Officer and their agents to enter on the aforementioned lands in connection with evaluating information related to this permit application. Property Owner Information: 0 Signature b .)41YlQ Q S he.'e Print or Type Name Title 3Q I '7 Date This certification is valid through l .?�� , 2-1)Z0 d ADJACENT EPAF,JJ' -:°' o:- ? rEfl. A T I hereby certify that I own property adjacent to fF, Sh cc 's property located at 4'1 r� S x.fl Sf- (Name of Property Owner) A.er.lress, Lot ! .toc ,. R. '. e ' (Waterbody) (City/Town and/or County) :<. The app' nt has described to me, as shown below, the development proposed at the above location. 'Imre^o otijootr, ; .his rz ,-;` I have objections to this proposal. DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT (fricrIvidual propos1n9:Ievefopme must NI 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 setbac";yoou must initial the appropriate blank below.) I do wish to wave the 15' setback requirement I do not wish to waive the 15' setback requirement. (Property Owner Info►matIon) ( dc�,- Rio : i ewer for at on) St re 3A€2J e — 0Nr P t or:Type Name Print or T �� 7/5 7 n1/9)1+- 1l A 4 4.7(10 m .�hM trdi off »` lr ,x City/State/Zip 3� z�3 3 City/State/Zip Teie ne umber `70` G I`-( C.) Z� Telephone Nun-) er (Revised 6/18/2012)