Martin (5)

/� CERTIFICATION OF EXEMPTIONA....--7----------
-..yr
, / 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 S it C �- t Phone Number cl 1 ci G Zq` r)7 US
Address 31 br oo K-- _Lj r'11
City -^ tt�, State N Zip a "1.5 +U
Project Location(County, State Road,Water Body, etc.) '?r u t'\5 W% c f- ( ou r. . 5. 2 I
nri 1Putnk ROt:\ri t Sv e c \ 1 -1 W Ui 1
Type and Dimensions of Project 1-' f1,r- of ci xk s-v. 't r'cl p",e-f
1^"(Su r` 3/1 r u . ‹., — V \k
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.
SKETCH c- 4,..) ln) (SCALE: )
4
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C\u1
Ins
of 'E-h 5
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
is a subsequent determination that a permit was required for the /.--
development. / CAMA Official's signature
1' kU-t,c, i_-- �D 1 avO '
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 &oZ J Q U U
landowners certifying that they have no objections to the Expiration date
proposed work.
Attachment: 15 North Carolina Administrative Code 7K.0203

1 S l,J .,.a . \ D^A ( ,/S� Sic' -7 7d &
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•
DIVI5TON OF COASTAL MANAGEMENT
ADJACENT nxRigruor PROPERTY OWNER NOTIPICATxON/w IVER.PORN
t.
Name Of Individual Applying For Permit: ,313 Yv) 4-7t+ x.,z
Address Or Property: 3S2 ) GJ t v�c`V 7 ;n,_ 4..6 A` ____
(Lot or �t , 'Street or Road, city & County)
I hereby certify that I own property adjacent:exit: to tl4Q! above-
referenced property. The individual applying for this permit has
- _ described to me as shown on the attached drawing the dG v e1opment
they are proposing. A description or drawing, with dimensions,
should be provided with this letter.
y I have no objections to this proposal.
•
a If You have oblections to what is being Promised, vlease write the
DlvW. n off_.coastal Management,_ W Cardinal Drive Extension,
Wiing(tan, North Carolina„, 28405 or call 910 395-3900 s ithi}n 70,
days of receipt of this notice. No response is corlsjidered the same
as no objection if you have been notified by Certified Mail
___.: __
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwatu r, boat
house, lift must be set back a minimum distance of 15'
from my area of riparian access unless waived by mo. (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.
X 3 ��toSignati _e _ „A. �� Cii� Do t a, ' :
Print Name
Wry — gyz - 5l 7 7 — y6° itim
ED Telephone Number With Area Code � �NH
b

3 (�J - n, cq(q) 21 -7 ? c>
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t� v���
DIVISION OF COASTAL MANAGEMENT
ADJACENT RZ$ARIAN PROPERTY OWNER tOTIFYCA'.t'taNLWAIVEzi _FoRg
Name Of Individual Applying For. Permit: 3-i3 M-*)e
Address Of Property: 3 SZ c
1 ijs,„ I -}-
Lot oti-dsttelet #i 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 a : shown on the attached drawing the development
they are proposing. A description or drawing, with dimensions,
should be p vided with this letter.
I have no objections to this proposal.
if you have objections to what is being prope ed, please_wr•ite the
DivitiPjen of Coastal Manaaement, 127 Cardinal Drive Extension,
Wilmington, North Carol& 28405 or call 910 395-3900 within 10
aays of receipt of this notice. No response is considprei the same
as no objeetionjf you have been notified by Certified Mail
WAIVER SECTNN
I understand that a pier, dock, mooring pilings, breakwater, boat
house, 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 appropriators blank
below. )
I do wish to waive the 15'setback requirement.
l: do not wish to waive the 15'setback requirement.
a g. a tur e bate_ i
AIe�L S �E�
Print Name r- ,..-
Sid -.�ry.� yoQ7. ._.�.
Telephone Number With Area Code