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CERTIFICATION OF EXEMPTION
FROM REQUIRING A CAMA PERMIT
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.
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Applicant Name s].- F- iY\oy Sp /0 ih'l t-� (ma( n Phone Number t`iq a( - &Dag
Address ? 2 , �e.-A-r t2 e S"r D g .
City �V CZ t c..%k-{-c.v i I t a_ R- G !-+ State NJ C.- Zip Z9,4-Po
Project Location-(county,State Road,Water Body,etc.) r' Fr9,,o-v-..¢_. , A-►- 1`14( ,.,$---
YY1 r> s c k er,.J►.l-pQ. tJ f-1,.i 1-t-h--ki 6v--e r .0
Type and Dimensions of Project L.1= n F -6 u_i_..ke.A‘p fveckizsb f 7n L_F 12t p
,Wit
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 _ ...,/4--
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sent of a CAMA official under the mistaken assumption that the Applicant's signature
development is exempted,will be in violation of the CAMA if there {�..1 � J
is a subsequent determination that a permit was required for the 7S L
development. to-
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CAMA 0 iciier signature- _
The applicant certifies by signing this exemption that (1)the ap- T
Issuing date
plicant has read and will abide by the conditions of this exemp-
tion,and(2)a written statement has been obtained from adjacent aj "'" --0 9---
landowners certifying that they have no objections to the Expiration date
proposed work.
Attachment: 15 North Carolina Administrative Code 7K.0203

MMOMMINIMMEMMEMMEMMEMEMAill

. DIVISION OF CO AST_AL_MANAOEMFI
&D.IAC'FN'T R TRAM AN PROPERTY OWNER NTIFIC.ATIONYIWAIVER FORM
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Name Of Individual Applying For Permit: J r, Me,^ (s o -�
Address Of Property: ,Sea c,^e s 4 • r r, •
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1,1 Gc�sv A9. c.. , 3c'Go
(Lot or Street#, Street or Road, City County)
I hereby certify that I own property adjacent to the above-referenced property. The individual
applying for this permit has described to`he as shown on the attached drawing the development
they are proposing. A description.-or...drawing, with dimensions, should be provided with-this -
letter.
t/ ! have no objections to this proposal.
If yev hav objections n what is being n=rennser,:l o_1�ace write the Divicinn of ('.oastal
Maii gemgt 127 North ardinnI Drive" von, North Gazn1ina 28445 or-call 91(?-:�95--
39OO withi •n 1n aye og f reca id reel the dame ae non 7i r ion
jf you have here notified by certified
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WAIVER SEr_TroN
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I understand that a pier, dock,-mooring pilings,-breakwaters boat house, 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.)
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I do wish to waive the 15' setback requirement.
I docent wish to waive the 15' setback requirement.
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„ 14.71-40 '
• NameL'Yz.315 C362— NCDENR
Telephone Number With Area Code • NORMGARGLINA Demanctrr OF
EN
VIRONMENT AND NOSURAL RCsOURcES

DIYISLON OF COASTAL MANkGF 1N'T
A.DJACF,NT RTPARI&N PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name Of Individual Applying For Permit: _ � r /- o r•r ..j
Address Of Property: 7
(--\JG' i (iCi y��� ��!' !l I,t__. U' =/S7U
(Lot or Strut #, Street or Road, City &County)
I hereby certify that I own property adjacent to the above-referenced property. The individual
applying for this permit has described toiiie as shown on the attached drawing the development
they are proposing. A description or drawing, with dimensions, should be provided with this
letter.
!). I have no objections to this proposal.
Jf you have clbjrrtinnc jn what is hying pressed. plow write the_ Division of Coastal
Management_17,7 North Cauiinat.Driva, Wilmington, Noah Carolina. 28405 or tali 910 195„..
39T within 10 ayes rf eipt of Lhic nntic�! Noi sponce is considered the same as no nhje�tinn
if you hue heen notified by Certified Mail
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WATVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boat house, lift or sandbags must be
set back a minimum distance of 15' from my area of riparian amass 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.
not wish to waive the 15' setback requirement.
137 c- � -�L _ ArCirre A
Signature Date
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Print Name
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Telephone Number With Area Code NORTH OLNA DowtTmlocr or
ErvvnmoMMEKT AND NALRAL RssouRcEs

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