Miller (5)

o CERTIFICATION OF EXEMPTION
FROM REQUIRING A CAMA PERMIT P 0 8 O8 13 Pt
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. tU4 `
?64- (tAS3
Applicant Name ‘�^' A l& tl\c \, \\(:..)/- Phone Number G I U 48(4- U0(O 1
Address S :�`� l d Mc-. Ir.rX Su» L h c K t i di
City 1 A < 4. A. 1:- , 'lf-' State Zip 2tU'3U
Project Location(County,State Road, Water Body, etc.) l r tt r1 W +r - U V." A , IS 2 9
urtint NAS -Rt.)AC) SvJ , ) 5hr, \1ot4-C , NC)
Type and Dimensions of Project i\)e_AJJ (fit e.r e\'r`4 C1uve�r e6 cl 0t .k� '1 o' 20
c�urc r,, - -U c ( P 1e..)F'4f r'1', (0 0 j e-r' re)e rsk Qt r\ cl .i ' OOUc-r () Ve-0
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 (SCALE: ts. (T To )
A
I w;de. ,
54eJ •
__. __ _-
____ir_nr,vvt
r_....r_ il wi 10, tir.r. ,,,,.- 4, - - -- -k,i ,,\
V y '4'
y ,r f 1-out ovu� do c -.
\} �� \r 4- fl UuCX i "\ r i,
4' okens‘ ; 4� oUer
l `Y ,� `� �,� it r �r' 4- v P ems, Wn\-cir
..5‘-,ore 4;nci 1-1' 15U ��.
Any person who proceeds with a development without the con- J ./�/ tf f t r ( / �� ,
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 �� 1
is a subsequent determination that a permit was required for the _—
development. ( MS CA �ticial's signature
'--1 u 6 a 00 I
The applicant certifies by signing this exemption that (1)the ap- t
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 6 f c.VU
landowners certifying that they have no objections to the Expiration date
proposed work.
Attachment: 15 North Carolina Administrative Code 7K.0203

7.----------N
Y1' \..S,
S' ,.11 (tV10 ' u..
- e SAIOW
----..'-- ,___ _,„,--,\ 'IN „ "! 1 5 ,,,
Ni C -4 N° (AA -
fl

JUL-17-2001 1:56AM FRCl�- T-355 P.003/003 F-653
u�1 J1 S)ECOASTAT. ANAGF.1ENT
A!VTR F0135/
Name Of Individual ApplyingFor Permit: •• -
Address Of Property: _
(Lot or Street#, Street or Road, City & County)
I hereby certify that I own property adjacent to the above-referenced property. The ;
applying for this permitindividual
has described to ine as shown on the attached drawing the development
they are proposing. A description or drawing, with dimensions should be provided with this
Better. '
I have no objections to this proposal.
n2gement, 127 Nq
if ynn jiamtleaLnariadav C,trtified Mail
-W 4JV R SECTION
I understand that a pier, dock, mooring pilings, breakwater, boat house, Iift or sandbags must be
se:back a minimum distance of IS' from my area of riparian access unless waived by me. (If you
wish to waive the setback, you mug; initial the appropriate blank below.)
I da wish to waive the 15' setback requirement.
��► not wish t0 waive the 15' setback
aci, requirement_
441te e••‘/CV A
i tore A
ate
&/1i4
Print Name
7L SG NCDENR
Telephone Number r with area Code ► +c•R,,,,,N ,,r of
ENVI ROMM£P7^NO NITLk OJRcES

JUL-17-2001 11:56AM FROM- T-355 P.002/003 F-653
Y
Y
R NOTWICATTON!' V 41fVVR FORM
•
Name Of Individual Applying For Permit: • ._
Address Of Property: 74)
(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 rtie 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.
If y'ou ve of j c inns t hept is heing_ r se e F hP r)ivigk of metal
M2nagemenr, orth Carnlin 91Q9q
if4caLhaye been nntifie41 by terrified_ ail
AIMINNY
I understand that a pier, dock, mooring pilings, breakwater, boat house, lift or sandbags must be
set back a minimum distance of IS' 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.
.t/ I cio not wish to waive the 15' setback requirement.
q
•
Sig�iature Date d A11:1111i1PA
Alimmeimm
Print Name NCDENR
— ' 9 eq1-7 —
Telephone Number With Area Code caRoUNA DEpaRTMeNT or
ENVRR5MMENT AND NegURAL REsOURcq.,a,