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CERTIFICATION OF EXEMPTION
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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 1-0 W n c'7 ` `� �� y'�� Phone Number(G�J)�"74E - 5
Address 1 b I ajj 0.-. ( 'is(.4 (J Ip r.
City t)u l< .J—s /-i 1 State C. Zip ' 7 W 6-5Project Location( ounty)j State Road,Water Body etc.) �1ar 2R � S�
gi)uf.c"I 4 boot huI / rD �� !7/W 3 �{ C .
hiA4 1 i. rJrso-,il Az C?.
T e and Dimensions of Project i t tel o 4- rc.M I' C<4 I-f t- 1 7,4,
-frioo Cti�... .. -P a r tr n • a -I r c.,"p . C o-9.] r►/• -&- I n r4 A S¢
(An Lrc #< W t 'Lk zf"' e, $� 1-dh a or r cr n ht.,-1- I owl -I or o v b if tit vtALA,.+�
A r((p�+ i :.-1 2)0 5 )•, 1 1 cm.4 r v �-( .i- or, a v r n�. ff•ci 4-,;,� t+a,.. -�� G P M t e 1�
Tle 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.
SKETCH /444t,W W (SCALE:Nc -p �j(.v le)
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Any person who proceeds with a development without the con- - VAieV / _
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 Q-1- a:,--- 0
is a subsequent determination that a permit was required for the
development. CAMA Official's signature -
The applicant certifies by signing this exemption that (1)the ap- 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 f - - )-I D I
landowners certifying that they have no objections to the Expiration date
proposed work.
Attachment: 15 North Carolina Administrative Code 7K.0203

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Name of Individual Applying For Permit: r*-.44 &� •:,:!
Address Of Property: 537 j- : • •
- or reel , i'list or•
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E hereby certify that I own property adjacent to the above-
referenced property. The individual applying for this permit has
described to ma as shown on the attached drawing the development
they are propos -g. A description cr drawing, with dimensions,
should be p with this letter.
I have no, objections to this proposal.
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VAMILAIMIN
2 understand that a pier, dock, gearingpilings, breakwater, boat
house, lift or sandbags must be set luc a minimum distance of 15'
from pry area of r3pariau access unlessinitial the appropriate waived y . (I blank ui :
to waive the setback, you gul
below.)
l do -wish to waive the IS'setback requirement.
j do not, wish to waive the 13'setback requirement
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easTACZ RspusAw .Paoaa _aese .NOTZPICkticaumzvaft zoN
Name Of Individual Applying For Permit: ,i i4 /..
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Address Of Property: 5 5 )r `
Lo re( AK:ii or lkusd &t, tunty)
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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 pr d with this letter.
I have no. objections to this proposal .
Z yp i have. Qbiect ions to what is amino o �laa�s e i;a t}5
Division of CoaeLal Mausgement, 127 Card ; Drive Extension.
Car9th116...2.M1-9X.G161622...3aLhin -iq
Sys re , of t„ i nQUcs, Na retvcnsa la considaradLtbe split
,, no ob j9g iQn ,1t you have .been not lied_ by Certified mial
totbraruitazz
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 access unless waived by one . (If you wish
to waive the setback, you gust initial the appropriate blank
below. )
I do wish to' waive the 1S'setback requirement.
14o nat wish to waive the i5'setback requirement ,
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