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CERTIFICATION OF EXEMPTION i. 01 } 1zU
FROM REQUIRING A CAMA PERMIT V C Zv ne
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. ( 42 q 3 (^lI
Applicant Name 1 , I (±vc c , Phone Number '1 iu 6,4 2- 6'4 15
Address 4928 V\A-r\lc .1 5t,,',1rk -eonA
City NA ` t\f State ,kX, Zip .284Ss—
Project Location(County, State Road, Water Body, etc.) "'$r t..t-,-y L„ f L )I,(M.A.-LA 1 .
Atc , tIr, . ,' in X\ck nfri1- MndCJ Cyr I
Type and Dimensions of Project plc,- ('c'l �cmc_nt i'd cl I D' x I uY C,�- �l r� uc L.
Ili) iiX t-- t lukik-r rinc- ►% eY.i5 ;r+
44 Na cnur•c_ -4-4, Cn' W;ca of' wA1kQAtA pA4corm mA-v1 hcJ oae-Ar NY((NLeyAsS ,
d t.,-,0r( --'1,.•= r, t,, 'i-t)4-10 or 2_ hce,.is' rlttnA-,, f'r,onr - At `' In.is St-ri,e- 1/ - .
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-
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 ..y.;\t). .8_5_...09
is a subsequent determination that a permit was required for the \ =\'`- _i �,
development. . CAMA official's signature
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The applicant certifies by signing this exemption that (1)the ap- `I',. an luI C;UOira
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 N-Yj'a I
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landowners certifying that they have no objections to the Expiration date
proposed work.
Attachment: 15 North Carolina Administrative Code 7K.0203

DIVISION OF COPq_TITLY;diAGEKENT
An,ZBCENT RIPARIAN PROPERTY OWNER_NOT'FTCTIONEWAIVER FORE
Name Of Individual Applying For Permit : 4/ Scce 0Y -
Address Of Property: /23 , �e/5 Sf
‘447 ,a Pack'! /v 4-2y/osairc.it_
(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 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 have no objections to this proposal .
Tf you have objarti ons to what is _bc.inu nronosed, p1 ease wri tp rho
Division of Coa�t_al Manaaamant , 1 7 -Cardinal Teri ya Fxten�_,nn,
W� lmingtor. North Carolina ?F34nc, or call 9 within 1p
days of rpraint of this notice No rpsnonsp is considp'r-od thP, sama
�s no nhjection if you have bapn notified by Certified Mail
WAIVER SECTION .
I understand that a pier, dock, mooring pilings, breakwater, boat
house or boat lift must be set back a minimum distance of15 ' 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 .
a-C-- /2� // `�2D
p4 Name �' Date
��F ,�LE2 ZI /<} jig/, %/�fD.o1/ SO,cJ
Print Name(-V9) >�/7- S'/.‘ Aitp.
Telen hone Number With Area Code
114 cDENR
N .�. :aR=I-IN:.Dmpar-rr=rr-07
=.NVI RDNM.=1:7"AND NKTUF-ML Pals^.,] s

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DIVISION OF OASTAL MANA GEXENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFTCATIOI(JWAIVERFORM
Name Of Individual Applying For Permit : ?XI, / e Coo 10
Address Of Property: 423
C. WC deA42rtd/6L
(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 me as shown on the attached drawing the development
they are proposing. A description or drawing, with dimensions,
should be provided with this letter.
vfl. I have no objections to this proposal .
Tf you have objections to what is being _proposed, please write the
division of Coastal Management , 127 Cardinal Drive Extension,
Wilmington, North Carolina, 28405 or call g10 195-1900 within 10
stays 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 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 waive the 15 ' setback requirement .
V ✓ 44_ I do not wish to waive the 15 ' setback requirement .
Sign 4 Jc Date
Cin y L � • �
Print Name) �►
V' 0 3 f 3301 - .�078 ____-
Telephone Number With Area Code 144 cDEN
NJKrH CAROLING. DEPAR rPl RT OF
ENVIRONMENT AND NGIILIRAL RzOUR::S

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