Bell

i - 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.
Applicant Name Tu bpi c.., -be Phone Number ot.)3 989- 2614 3-
Address 3)-4 Si.\6\l x.J --- .1-ciuk -tir-K-
City ^�uk,j ,,�1,,, State Q.- Zip Zct-,a
Project Location (County, State Road, Water Body, etc.) -1e,,r u_.s w t (. (Qt r\�q , 1 H 1
0 s.5\{, .t)e. c.4- 0c eR.f, ss 1-e__. , Q \cl ,:c":U LA_r'.d 1
Type and Dimensions of Project P, ,:„r, y-,-(NJ f lu 4-, r,,-1 d o c L--- l� Y Ito
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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Anyperson whoproceeds with a development without the con- A7�
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sent of a CAMA official under the mistaken assumption that the Ap an' signature
development is exempted,will be in violation of the CAMA if there
is a subsequent determination that a permit was required for the
development. A Official's signature
The applicant certifies by signing this exemption that (1)the ap- t �� o a�
plicant has read and will abide by the conditions of this exemp-
tion,and(2)a written statement has been obtained from adjacent - . .? &00 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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JUN-20-2001 12 :01 PM 7 908 879 8395 P. 01
•SE P, U A:140 2IB2PH tiCDEN4 WiFtO I•IU.uL'.1 I , 1 '
ram'."
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Nip Of Individual Applying For Permit. ' ,c i 9
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Address Of Property: c,'-•., ' ▪ .'. �s
1r�r
eft l..:1:.� •/ i 1 � . ' - —
.(Lot or Strut#, Street or o>d, City&County)
1 hereby certify that I own property aunt to the above-referenced property. The individual
applying for this permit his described ta11 a Re shovwti ou the attached thawing the development
they ,are proposing.. A description or drawing, with dimensions, should be provided with this
loam •
-,� I have no kibjectioce to this proposal.
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WIthin 1 •i - "{t .,1, 1 . P : .to t-- . . ..rt•• 1 .-. . ..• . .-1 u: 1 t •I. Mai 1.
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NADDLUECIVIV
I imderstand that a pis,dam, mooring pilings, breakwater,bast house, lift or sandbags mot be
suit book a minimum dist = of 15' from my nos of riparian access unless waived by me. Of you
wish to wiiva-tile Whack, you must��appropriateblank below.)
1
"2"......"' I db wish to waive the 15' setback requirement.
• I&net wish to waive the 15' setback requirement.
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I A Date, ArvnirA
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'7'elephoute Number Whit Mee Code ' INV ,a,►o M

SEP. 5.2000 2:52PM NCDENR WIRO NO.629 P.4
DMISIOMOMPASTALMANAGFPWSIT
ADTACRNT ,R NO IFICATIONtAIYERY RM
�u-
Name Of Individual Applying For Permit: �/ Vim
Address Of Property: /417 0c`!"5`-./ ' s( t es
G.- 7g.
(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 toliie 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.
inn "nave onia^^:,ric rn wha. is being nrl, pleas write '
Management,
rth Carnlina, 2R405 or calL9111 195-
•^ • y • nnti e Tn r nnse is cnnaidered the came as no objecliOn
jf yo by Certified-Ma
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 me. Of you
wish to waive the setback, you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
I donor wish to waive the 15' setback requirement.
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Signature
Date r
o�� LIS , � � � l�z
Print NamNCDEHR
NORTH CAROLINA DEPARTMENT OR
Telephone Number With Area Code ENVIRONMENT AND Nauru&Rrsouncris