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CERTIFICATION OF EXEMPTION
FROM REQUIRING A CAMA PERMIT N U' l i U I U C
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 ci- L o C Phone Number
Address .,3 \oS deie.5,(eJ CcAur t
City Ira 6 +1- •0 11( • State it) v Zip z,� (,)j
Project Location(County, State Road, Water Body, etc.) r u 1-1 vs) - rn wn I.3-7
3-i- N c C•.sh *10 A L c lr,t M Pm- + 1 f\( Can 1
Tye and Dimensions of Project NP_AJ. �J e4't <-TvcL E k ( ENA'tnr\ aUck-- C��xIC0
I-IoAA crn,, \-0V( _ b �,pe--s s. �1e.4 s on front L UnC S,ccC nL„A 1--u("-
Pc
fr mar, a a o , Iron +-,E o ( Ac+ 5k,5 1v br,6 s�
i- t\Qt C7LCe- e i r pre-"- i(� or' efIc s{
lua gnus �l�l �. d p hcn d I e.� de.,)
Tlie 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 (SCALE: N uT --1-( )
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Any person who proceeds with a development without the con- 1 _t �,,. _C c '\-.
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. 6ffici
al's signature
The applicant certifies by signing this exemption that (1)the ap- . �U 1 aUd
Issuing date
plicant has read and will abide by the conditions of this exemp-
tion,and(2)awritten statement has been obtained from adjacent ,( �C- „8(i.2`/ 10 'DUO
landowners certifying that they have no objections to the Expiration date t
proposed work.
Attachment: 15 North Carolina Administrative Code 7K.0203

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DIVIgrON Or COAST
ADJACENT P.?pAPIaN p�0?cRTy 3L MANAGEMENT
gpRM
. Name 0= Individual Ain • •
pplY"�g •
For Permit: 0/. Ve)
Adr'r esss"0f Property: l yi . •
klV .
CLa Or Street � Street r _
. o- Reid ,
• City & Countyy . -
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hereby certify that
I are -; I own t
describedcd Property, The Proper y , adjacent to' the above_
` to o as individual applying
l? V are proposing.ma shown on the attached drawing for this evel it ent
should d e A description or drawing,
the development
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e provided with this letter, 1eg, with dimensions,• '
I have •
—� no objections to this proposal.
=r VOLI have Obi i •
,vie �n ,: or.s to what is b ;
e_ e_ne r
Division
Wivision '1 . NCoasta Manacelent. 1 7 C ODOceri, rive tens t`,..
l �-,= r`'r-c+0`orth *- in= . 28405 o7- Cell Cardinal v_ Extension.
c- this notice. - 9I0 3S5-3a0J within.
� �10 OG^ .-i.i0]'1 i = OL O ZSvOnS? i� � - -� !�
- c vcu have been notified by cons id=_T_d tha, a ,
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erstand that a C+�
1 and list pier, dock, mooring pilings, breakwater,
a_a_ must be t tn boat
from my area of riparian a set back a min,�un distance15'
waive `a setback, you access unless waived by (If of is
ma.to
initial theappropriate
YCu wish
�+ epOr Opr ic''tc blank
* ,.---+__�_ I do wish to waive the Ij 'Setback requirement.
nn Ili,
�4i" 1 CC not wish to waive the
I5 Setback re wire ent.
Sic, 'cur 4
,. �}i�C /4 • L 6/U Date
Pri:�lt eta (
�!-U A • A
Telephcne Number h �
th A-aa Code E �FR

Page 1/1
Jun-26-01 12:16;
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(91o) ei42-3989
.Jun-26-01 12:16121Cell3f Hewett ftelow,
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4411 COlktf. 914/4r•
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A^.7P,:.C.t.:NT RT.P:=.R .AN Romir.FerV 4-Mr NO^-Pi AT OV/T:A17-R. r -II
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_ Name Of Individual A:,plying For Permit:
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Address q;.r. Prope*-ty:
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NC0
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(Lot or Street #, Stripe,. S1771-87/27-672;77r/5 .
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1....herm.1.-y 'icertify that : own prope,-ty , adja,-ent. to te abovci-
r=feranca.li property. The individua2 enply4ro fo- th;s odirmit has :
des=ribed ma as shown on the attached drawing the dvelotment
they ere proposing. A description or draw:,mg, 1.-it dim.ns4ons,
shculd be Provided with this 2ette-.
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I have no objections to this p-opospl.
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7.-' vo • .av s:i '-le.--• ion -c wt., t is bei-c t-oo se t li.c 1.--i"e -- *
g4ilm4s -0- - " s a" li.1,a . s. •,- a 1 : -..34. ... wia- in -
i : . i im-ad A. e grin-
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EileaLl-Alg2Zar
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understendat a pier, dack, mooring pi2itgs, be..;:wate-, 1.oat
house, lift ;:i '.
ir.ast be set beck a mi4Mum distance clg 15'
from mv area :1-of riparian actess unless waived byte. ri? yo., wlsh
to waive th4 seti.ack, you Eug4t initial tha aporopziate blank .
taZow.)
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:f1 1 do wish to waive the 25'setleack requfre!flent.
ipy,
" Alh vs:a_tot wish to waive the 15 'setback :requi-ement.
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5a.gma-..re
pate
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Print N.eMe -
E) 1--IT•Ji=tt
Telepftzne Nul"., a - tilth AZZA code .
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