Pritchard

CERTIFICATION OF EXEMPTION
FROM REQUIRING A CAMA PERMIT p 091614 A
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 ( ir
4 0 1 ' t k c \l l A-- 'd Phone Number (n i j2 2-p 13 2
Address I051 VA or r't fs\e Uie..AAi tJr ,Je d
City -;, ^ 11 -, * ,r\ 1 State -54 Zip YitY.o(n
Project Location(County, State Road, Water Body, etc.) r a SvJ,C.v.- C o t_A I&4 I -FAr
T)t 'tJE/ i k-\ .fin e 1r, ( V r\r ~.* 10 (V\Pr-r\ - M F-1,r1 t J C
Type and Dimensions of Project \f uJ 'Q. ern C I cu psi-,A- cj o r +�_. B ' x 2 U'
ti6A# j— 'd co ork ' 1un*` 1ruc k- i. i- e,cce-rcj J t/.3 IJ ,c1t`h cf I,V( .-,!'hrci
• (` 51.- .rle-,t f\c j . ,c:f ti.-11,- t - ,s,".,r ,- C.1V,,e 4.` t-v 1„,,,A k LA.c A
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: ljL To )
< — 20� >
$s I pro osr d — V IOAT A > ivi
vF Z
kJUAi S GALA
4'`i 4 �` �~' rnoo r' �/ t.
i ,1- ��' v- 4- , vo-to ''` .r V' �' \I V `r
I l
5v� LOT `
Anyperson whoproceeds with a development without the con- z N--
'ih�`( ��f f
P
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 c `�L—.
development. CAMA signature
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 J , e f _001
landowners certifying that they have no objections to the Expiration date
proposed work.
Attachment: 15 North Carolina Administrative Code 7K.0203

•
DIVISION Or COASTAL MANAGEMENT ADJAC=NT RTPyRIAN PROPERTY OWNER NOTIFICATION/WiAIV=P- FOR!
. Name Of
Individual Applying For Permit: C/?2 4 C. /�/z i fc/a/�,e (J
Address"Of Property: / / T i,tiq ,dR
•
•
0& ��N H A/ e
�/ /� JW�(Lot or Street #, Street or Road, City & COul'.ty) •
I hereby certify that I ownr=prope_ ty , adjacent to the above-
referenced property. The individual applying
described to as for thispermit has
arethey me shown on the attached drawing
should proposing. to description or drawing, with the dimensions,
development
provided with this letter. ns,
�/I / I
�.. have no objections to this proposal.
•
•
T` you have obiect i or.s towhat
Viof OZ of Coastal o Mc is beinc br000sed D1 ease write the
T�ii 1-•; ion aement . i27 Cardinal Drive Extension .
�'.
d_vn_. North28405 orcall - - - on .
ddays of rec=; p` of this notice. 9i0 395-3500 within 10
a n0 f r�r'tiOn i r No res:onse is considered the same
You have been notified by Certifier;�-- - jViai1
FiAIV SECT.ON .
I understand that a pier, dock, mooring pilings, breakwater,
house li f= pil- boat
must be set back a minimum d_st_nCe of 15'
from my area of riparian access unless
to waive the s ess waived (If
you initial
n by me. youwish
below. ) setback, must i t i al the appropriate blank
/'' i do wish to waive the
15 'setback recu i cement.
I Co- wish to waive the 15'setback requirement.
•
ArgiCh
c, t _ e_ e
�, to
•
� .
Print Na ,r
Telephone Number WithArea --�
Code QI HfN1 �
I

•
•
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER- FORM
. Name Of Individual A_nnlying For Permit: � I/, C •
p� ,2,J
Address Of Property: /. / jcJ iv/ ,n 1_7
ci"7Sw/c J
(Lot or Street , , Street or
Road, City & County) .
i hereby certifythat
• referenced property. t I own- property , adjacent to the above-
referenced
to oie asy shown The individual applying for this permit has
described___ on the attached drawing the development
they are proposing. A description or drawing, with dimensions,
should be provided with this letter.
•
©: •
�J.
i have no objections to this procosal.
•
IfIf VOLT have objections t0 what ; •
Division Of Coastal is being nroDosed , ble==e write t
tivi vision 1_ � a Manacement 127 Cardinal - - _�_ �.n-
Wilmi•icton . North Carolina 28405 Or- call c DriV� Fwi th i i ono
_ days of race?ct cf tili = notice. - IO 395-3c00 'vdithin i0
as no _ you h Va bee No Lespcnse is cons i dcr_ro' the same
- been noti - ied by Ccri;
WIPER SECTION
I understand that a pier, dock, mooring pilings, ,
house, li=� rc_, break;„ater boat
- ` must be set back a
from my area of minimum distance of 15'
riparian access unless waived by me. (If you wish
to WCivA the set
below. ) --r-cC}C, you must initial the appropriate blank
I do wish to waive the 15 'setback requirement.
_ I do not wish to waive the 1 t
5 se�rack requirement
•
•
Si lure d6 -- ..
6 - • Ater
A/ DateATC:cirA
Pri•. t •
Ni�
Telephone Number With Area Code D�H

, 0Z-
. y
>t
8;417
•
d
oi Y, 3
a
- ;FA&0 I/ /n..1 1 17
_
>I,20a 3-5-0,010c1
•