Bitterton

CERTIFICATION OF .EXEMPTION
FROM REQUIRING A CAMA PERMIT p p q Z.(oick J3
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 F rPm\L, e/ I 4+er+o n Phone Number 4J 4 5-N3I3(o
Address -1 S 5 f on0,, "Y1',11 E_uP d
City A—rm.),!' State \J &' Zip 24 A,4. I
Protect Location(County, State Road, Water Body, etc.) �1 r u rrsu)',c f-- C o 12 t irS
rtieJ t1 ,.' e c h , �\r ,'fin de J C'.11e-y,A•
Type and Dimensions of Project e\A� - t_ s� �� 1) - r� 5 0' , 5 c
-\ ,'-,." Lk)A 1 !
1uty15 �lv�� t' �u �',n -our
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:
A
i✓;'
.' } for 1
e' x �o' Voi.j,df t Y:tS��nr '
50'
- A-
I o SPsyy-Ne \ ur tea gun
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 thereYrNN
is a subsequent determination that a permit was required for the
development. CAMA Official's signature
ca , 2Uo1
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 bad+ �4
landowners certifying that they have no objections to the Expiration date
proposed work.
Attachment: 15 North Carolina Administrative Code 7K.0203

.ENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY
• Complete items 1, 2,and 3.Also complete A. Received by(Please Print Clearly) B.A. o f Deliver
item 4 if Restricted Delivery is desired. 1- Y - / /V. C- 1—VasOC
• Print your name and address on the reverse
so that we can return the card to you. C. Signatur: y
Attach this card to the back of the mailpiece, X ? J � !.� �/ ❑Agent
•on the front if space permits. ,. ' `—/ 0 Addresse
D. Is delivery address different from item 1? ❑ Yes
Article Addressed to: �4- i If YES,enter delivery address below: El No
3c2 6 'r u,N� 1v�
rl�t 71/I,` t'-'C3. SSee ice Type
/) (
910 G ` - Certified Mail ❑ Express Mail
J 0 egistered 0 Return Receipt for Merchandis,
❑ Insured Mail ❑ C.O.D.
4. Restricted De '(Extra Fee) ❑Yes
2. Article Number
(Transfer from service label)
PS Form 3811, March 2001 Domestic Return Receipt 102595-014A-14

ass Mail
&Fees Paid
1 11 11 1 I ..,,..No. G-10
• Sender: Please print your name, address, and ZIP+4 in this box •
`SCE'" N ��1. >r►l/17 G
8'94) a

.ENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY
• Complete items 1,2, and 3.Also complete• A. Received by(Please Print Clearly) B. Date of Deliver
item 4 if Restricted Delivery is desired. A ILK A FtC I Sc f41104.0 I aft�r. -Zoo,
I Print your name and address on the reverse '�"
so that we can return the card to you. C. Signature
/��� /�
Attach this card to the back of the mailpiece, x, l ul t Q ul.Aa � 0 Agentac 0 Addresses
or on the front if space permits.
D. Is delivery address different from item 1? 0 Yes
I. Article Addressed to: �_ dd If YES,enter delivery address below: 0 No
. f7� /�-C IS ��iCL Fn..
3. mice Type
It- !� L' Al ' Certifiedeggsr Mail 0 Expresseturn MaRel
ceipt
,`) //�v ❑ Registered ❑ Return Recei t for Merchandisi
"1• 0 Insured Mail 0 C.O.D.
4. Restricted Delivery?(Extra Fee) ❑Yes
t. Article Number
(Transfer from.service label)
•
'S Form 3811, March 2001 Domestic Return heceipt 102595-01-M-14

UNITED STATES POSTAL SERVICE
11 11 First-Glass Mail
Postage&Fees Paid
LISPS
Permit No. G-10
• Sender: Please print your name, address, and ZIP+4 in this box •
C . k
en en'1•- 4>) S/119
gupp .e •
/
I e I ; ir . 1 , tif iif r I i• II

N.--40 231A-64 At-e77-C -, .
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
•
. Name, Of Individual Applying For Permit:
i ' , /
•
Address ' Of Property:
(Lo 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 me 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 you have objections to what is bei 'na proposed . please write the
Division of Coastal Manaaement , 127 Cardinal
�'+ilminaton . North Carolina . Drive Extension ,
na . 28405 or call 910 395-3'900 within 10
days of receibt of this notice. No-..response is considered the same
as no objection if you have been notified by Cent; f_;-`d.
Mail
----------------
WAIVER SECTION
I understand that a pier, dock, mooring pilings,g
house, lifts, breakwater, boat
- must be set back a minimum
from my area of ripariano distance of 15'
access unless waived by me. (If you wish
to waive the setback, you must initial the
below. ) appropriate blank
\ •
I do wish to waive the 15 'setback requirement. .
I do not wish to waive the 15 'setback requirement.
•
-i /
4,1,_ a •
o s, cg 7OI
, .
. .
Signature . ---:- --- w ,. 4411 0
IY`��121� 2�5 C{� tin r Date i` ..'l o ® �
Print Name Fp�, ., �µ�;
r(/ 4 K
I J` -.
�o Kor.1r� (es�) 2-86 f
Telephone Number With Area Code
envei4 - lets G n e'l-V gctforf`b Com

Y
t

•
. 41-14,4) B1A-L4 Atve-tO' .
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER. FORM
. Name, Of Individual Applying For Permit:
Address' Of Property: A,Z/ b ,t./.5 /90a44,
.C� r.,�7 ,8v /V.0 .
(Lo or Street #, Strut 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 as shown on the attached drawing the development
they are proposing. A description or drawing, with dimensions,
should be rovided with this letter.
I have no objections to this proposal .
If you have ob;ections to what is beinc or000sed , ulease write the
Division of Coastal Management, 127 Cardinal Drive Extension,
Wilminctcn , North Carolina , 28405 or call 910 395-3900 within 10
days of receipt of this notice. No response is considered the same
as no obiecticn if you have been notified by Certified Mail
WAIVER SECTION
•
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 appropriate blank
below. )
I do wish to waive the 15 'setback recuirement.
`./ I do not wish to waive the 15'setback recuirement.
—
'
Signat e — Date •
l /* 9i c-,
Print Name
�e y
��.��. ,�- E F I--1 NI R
Telephone Number With Area Code