Testa

. - CERTIFICATION OF EXEMPTION
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FROM REQUIRING A CAMA PERMIT
as authorized by the State of North Carolina,
0 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 LC'on ecr d TES Phone Number 842' 4SS-S_
Address 32 Z. t(l Nc k ems' 'S
City 4‘ ` ' e.."(- L. ( 5 4, �040 State NC.1) Zip a 84(02.
Project Location(County,State Road, Water Body,etc.) ,..4 A' - 3
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Type and Dimensions of Project Ne.,.,.1 lPk.k 11c_1-..e_c J f 1 A-nAk4ftr d_ of 404 WE A-I Ne-Nd S
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: jj- Tf) )
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Any person who proceeds with a development without the con- 11)
sent of a CAMA official under the mistaken assumption that the 7 Applicant's signature -- __ Hla
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development is exempted,will be in violation of the CAMA if there L ^ - - P
is a subsequent determination that a permit was required for the j l
development. ( CAMA Official's signature
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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 iv 1 (. .kv i 1 cD OU a_,
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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D ^_ ;06" O1 04:06p L 8, J Testa 910-842-6125 p. 2
DIVIaLCN OF COASTAZ, MANAUMEET
XDJACj T R:pARIAN PRQPJRTY OWNER NoT p/cATIoN/WAIVIX FQ +i
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Name Of Individual Applying For Permit; Low er - ,
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Address Of Property: 3aa E,1, K frT. 5 ,,
6 e a ,J $EizlC.J1 N C- 28 y(a,21- _
(Lot or Street #1, 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 - as shown on the attached drawing the dOvelgpment
they are pr- osing. ..A description or drawing, with dimens;.ons,
should be ovided with this letter.
I have no objections to this proposal .
AIMP
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If vpu have obiect.ions to what is b 'n onosed ea e w 'de the
Div.f sign or Coastal a anaaQment 4 127 nil Card '
�lye.Fxtt~ns_on
Wi:�m,ing .n•Northrge8405 0 �Go , r call 9_0 39, -J90o wit vir. 0
days of tpeiRt_ of ttLi,s of ce. No response "
at� o obiY �, -� considered 4he� same
eCtio if of nave bee., 7notifket.ky Ce_tifred
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WAIVER SECTION
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I understand that a pier, dccbc, mooring pilings: breakwater, boat
house, lift or 'sandbags 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 pus; initial the appropriate blank
below. ;
I do wish to waive the 15'setbacic requirement,
I do not wish to waive the 15'setback requirement.
s.ig �. _ Date
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Pr ' t line
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Tel _ hone Number with Area Code