Sturdivant

CERTIFICATION OF EXEMPTION
FROM REQUIRING A CAMA PERMIT — 50 t/c,r, 2D A-
as authorized by the State of North Carolina,
ti 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 n A✓vim S ,e 6,,P t),(,AN t, # li K7 Sfr R Phone Number // / "?(/) 3 23 3
Address ' } j . RC Ft r
City r • • ' State /V C- Zip
Project Location(County, State Road, Water Body, etc.) /J a / 5"" S""/
4ri c e- (AA.A / vn. S/J eN, Ce
Type and Dimensions of Project 3,,, 1, 0-e-4 l) --e!$G{,'►^Pn�'�
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:
ft9 r)° (}V\1\
tug
ci p t7o.-
Any person who proceeds with a development without the con- At J^
sent of a CAMA official under the mistaken assumption that the Appl is signature
development is exempted,will be in violation of the CAMA if there
is a subsequent determination that a permit was required for the
development. CAMA Official's signature
The applicant certifies by signing this exemption that (1)the ap- d y
Issuing datee
plicant has read and will abide by the conditions of this exemp-
tion,and(2)a written statement has been obtained from adjacent
landowners certifying that they have no objections to the Expiration date
proposed work.
Attachment: 15 North Carolina Administrative Code 7K.0203

DIVISION OF COAS 4 T I`'I e 7
• ADJACENT RIP&RUN PROPERTY OWNER NOTIFICATION
TL'4'4'AIvEB FORM
Name Of Individual Applying For Permit: vodi �/ ✓��. vjj:.
Address Of Property: /p ZZ /Si,Sr
,Svc7.4 (, /VC _.
(Lot or Street#, Street or Roa , City & County)
I hereby certify that I own property adjacent to the above-referenced property. The individual
applying for this permit has described to nhe as shown on the attached drawing the development
they are proposing. A description or drawing, with dimensions, should be provided with this
letter.
A—
ve no objections to this proposal.
•
I�y�have n1LjPrtinnc to what is inQ nrnnncPr� n1PacP wrirP the•
,•
r �'nactal
•
if you have been notified by Certified Mail
WAIVER SECTION
I understand that a pier, dock, 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 must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
I ft) not wish to waive the 15' setback requirement.
•
Sige' li
/� Date ,,
Print Name
•zJ>" 3 57 NCDENR
Telephone Numb,.r Wit
h Area Code NoI3rIy cARouNA DEpARTM-NT OF
/ �'r— ENVIRONMENT AND N
/19 f S�- NATURAL RsouRces

•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
. _rf/+l a'h•,,/. p, `a j: °..te.vw'�'" : °�/��+!' •' •
apcb a24d'�atm. .,� q�r u
►iit..•aucc$ 'az
�"-
' t ryry a •. aural/ .,Arrldr •
GWR
•
•
•lka =+t't44x •I•tovq4es,st etp. $rt aC► Al ,ttSrit •.;Qu q I •
..•4u*.aa.-17nba.: xeegtas,5z inn*. aAtget e; gstrl.gp .1 : •. . _'•
•
4.
•
•
xcrgZq �;atacxactoz• dtT� taxes ur • f •
xt r:r .e .. a� F ' • noir • ..X�tgq .as "a (•£Oz q
' ,SI .3n no/t.
) q air ssatun Ssaoae..ttBT 0 �A��iYS 'z•�, .
. • ..Taa •- � F0 ainurxu;.m E. )(nog 4as 4q ysrtit4 • .. T:: . aas .,r,�. a<r�q 4A a ,5taiaaq.• 'sburrrct•buTroctc "•{ee:p. '.� tad. "4 ; � � K
i' ag;t®
�� p.?�wszstc[t T
•
•
•
• 6�
a a..
•
' ..e•
oa o �. p:. .
pq �4 A ,Pd 4 i sua �. : •
: -,.
a
g; o suoT aCq®.'ou eiE.± —�- . '
'strc�t
Ps,
auatidL" ' -•1034at sart; L[4TA B rn•
o2d.a •. ;sUo o. ansp ;Trt 604TA ,Tp xo rra-cUdFsass P.
• p• Q Pt'iogr
•
•
•
•
se p t ; •euTivaxp pa e4,1,p a �. •puTsacla.xd..zzi:
Td . rc;4. z03: .6uY.(jr�c�• �npt it�®a"° , Se.•ana..a.�: pagtzsr
- naqi ;aq . .l . Susan[ •a F y� ' 'et:a.is4dozci • 'auasa*jap =•.
•
• P et�ao�ds: d v�1a j fie. /{ t. xsa dc{a,,�p4
Ja �S Zas424S ae 707) • : : • • .
r��y,�: �a� d �4 ss�apP�i
• ,.5 = t ad ,a®4 •n t cTdd-d`t t p ATpuI ZO •a
•
•
�t0x A ki �O ,d[I O
•
o.SA r
•
•
•
• •
TO ' a�ttr� ' . N71:1E3103N (IV tGJ_EBLFaT.fi BG Lo• '[71 T.,''P t'