Blume

CERTIFICATION OF EXEMPTION
FROM REQUIRING A CAMA PERMIT P 0 9 2-Cc Imo{ f
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 I_Prr r L.1 �l‘u M Phone Number 7 U cI CG 7• c&7(a
Address in-o 15c k ‘k51-t-r- (vour
City tna k - h a State 1.Jc _- Zip a8to
Project Location(County, State Road,Water Body,etc.) 3 c u rv,uf,c k_ ( o tAt."4- I0 8 n s PA w
pQtr‘c r. P:f lr (AAA( ( -v1A \
Type and Dimensions of Project TA 1.-r_ c.),A It.cd toc t_ ire-„ci r e,_ 1r rc_- Li,1► 'h
.Jt ' i �c E �� 6ci. )cL ex� k ;tncl Ioa4 LA'► It C 'fA .n
(8' . t 5' c' -c c , 14'
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: )
to tom• f1 f\C ( aa eq.
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Any person who proceeds with a development without the con-
sent of a CAMA official under the mistaken assumption that the Applicant's signatur
development is exempted,will be in violation of the CAMA if there
is a subsequent determination that a permit was required for the �s,'� �
development. CAMA Official's signature
The applicant certifies by signing this exemption that (1)the ap- --,�L'� '
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 Lt� . ..2 L W
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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P MGF BUILDERS, INC.
. 125 LUMBERTON STREET
HOLDEN BEACH, NORTH CAROLINA 28462
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Jill'. k.,_ ll_1:--?;._ >•il' • U. ,- i •T i.•- ;i• _«• F .C
n:yT.sioN OF CCASTl`.Y ?f..�1NAGEMEN •
?A RTP?,RTAN PROPERTY OWNER NOTIF CATION jw?.i . roam
Name Of Individual Applying ^c: Permit :
AR , 610me_
Address Of Property : . 1 d gg 41.0i, �.1.AL_____ -
____ArlizciPk) e.t.a. _ .c_
(Lot ,
or Street Street or Road', City & County)
1 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 or drawing , with dimensions,
description
should b- rov_:�ed with this letter.
. r 40.1 - have no objections to this proposal.
•
If you have cb-iect ions to what is beina to Ooosed . ` lease write the
Division of Coastal Maraceme-t • +V7 Cardinal Drive Extension ,
.ri _r,,. i7r irlrJ t,Jr ''orth Carolina — ?8405 or cal o '=5-Z9OO within 1.0
-
do ys of ren o of_ this nor•?c_ e . No '_"eeoonSe?s considered thesame
ZS no :_'Cticr. if You have been, notified by Certified Xa 1
WAIVER SECTION
7 understand that a pier, dock, flooring pilings, breakwater, boat
house, lift must be sat back a minimum distance of 15 '
from my area of riparian access unless waived by me. (If you wish
to waive the etback, You 7.,;si initial the appropriate blank
below. )
T do wish to waive.. G. 15' setback reauireme1-i t. .
12 I do not wish to waive the 15' setback requirement.
•• ,.r � -� 8 --•. __ gate_.._.._.._ I
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Print�Nare D, 7 - -- - - -- _� NI 11-
Telephone N.n:itter With Area Code

OF COASTAL t �r r
r _ -
ADJACENT Z7'TPMZI N T:7 o'V•o x' IV OWNER OIFICATIO NOTIFICATION/WAIVER. FORM
,�• r Ir� r4
n /� ,� _
Name Of I17div dual Applying For Permit: _ -_ J2-lam LL Ait-2 i1q
Address Of Property : ,La li A -) h.2' .
. .__,AoLJ
(Lot or Street # , Street or woau , City & County)
1 hereby certify that I own property adjacent to ths above-
referenced p,-operty. The individual applying for this pe:'%:i t has
d scrib_a to ma as shorn on the .;*tao;";c"'..la d-a'n�i. deat.1oprent .
they1 .7arlLeµ proposing . A description or drawing , ywith dimensions,
• should be roved with this 1,,tier.
rave no objections to t h s p=oposal . •
If have cb-iec'rions c what 1,5 bsina pr000sed . Please write th
Division of Coastal Mankpement . 7)7 ga•rd na1 Drive •Exte*^ io_,..
W.ili.ninaton . North Carolina _28405 or cad). , I0 3:5-z000 within 1.0
:ays of •.^s i'P tc this not.7 Ce. .._No response is considered the same
• lio ob.ient io'' :if Volt have been `':G'ti•f'ie+&l JV Certified Mail
...____._ - - -... --- --- __may
• . WAIVERSECTION
I 'understand that a pier, dock, noon i:ig pilings,ings, breakwater, boat
- house, ,lift I'ust be sat back a minimum distance of 1 5 t
from my .area of riparian is access unless waived by re. (If you wish
to waive the setback, you _T�i.�Bt, yiniti,al the appropriate blank
below, ) .
r_ ' t-h k recu`i,r'e3i!e2'rt.
do wish to waive the
`I'- i' --w_..7 not Ot wish to waive ;'the l � Se��GC :e=7L'i t e:lle:7t .
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' i�T^atur Date iktY �4, f 0.
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