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Y CERTIFICATION OF EXEMPTION FROM REQUIRING A CAMA PERMIT Cs( J J ?
S /0 /f/4
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 ' oNN C
!� 1 , C`C 5 (Pri-, 4 A&e fin►e5 J Phone Number ' `1 1 1) 7& , .6776.
Address 1(@ (o O cej
p eNL y /�f
City �.y ---1t I ; P I State �CT zip ' 75 7 7
Project Location(County,State Road, Water Body, etc.) 1/v..)5- c 6- . , ff r 4CP1.i f)14v-� O e
e4NR I S A R{ C;-f ,, o n,Sr'; . ('_5) . .1
Type and Dimensions of Project g ' Y. 9 'O C 1 / ) Pi " Pc
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: )
0 a Alpo_
T lc-F, , ;
(6"'N't) ___.___ _. _ . ........______._
tit
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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 Appl.ra(6,..01:/r
n red`
development is exempted,will be in violation of the CAMA if there t/
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- //E\ `) !
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 a 3-- U
landowners certifying that they have no objections to the Expiration date
proposed work.
Attachment: 15 North Carolina Administrative Code 7K.0203

I2L�TSi()'\T nF (`n4�TAT 1�'t4NA('F� >`,-,,
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Name Of Individual Applying, For Permit: r.
Are)
Address Of Property: o zs S74
(Lot or Street it, Street or Road, Ci & County)
_ - " -- I hereby-certify that I own property adjacent to the above-referencedproperty.applying for this permit has described.to-nie as shown on the attached ngThe the development
they are proposing. A description or drawing, with dimensions, should be rovided with this
letter. jti%1 f)( 7 1
'yam I have no objections to this proposal. 0 II-Jite-79-
•
cr
. a
1 A
If von }1�VP b i, not171Pr1 by !�
•
I:understand'that a pier, dock, mooring
A pilings; breakwater, boat house, lift or sandbags must be
set back a minimum distance of li' from my area of
wish to waive the setbac riparian access unless waived by me. (If you
k, you must initial the appropriate blank below.)
•
•
46_____ -I do wish to waive the 15' setback requirement.
I.do not wish'to waive the 15'-setback-requirement.
Arilyr
Signature .Date 11, im„,..1....., ............„
.� •
Print Name
mCDENR
S776 Le-..-1r ,4.,.e
Telephone Number Wi
th Area
���f Code Nortny �+ROLINq Drs
.re! 9 e . OF
0 / e ENVIRONMENT AND NATURAL'R�oURCS
if• Ch/VAItj4,i, Slej Z.. 1TLf0 r

a.
DIVISION OF COASTAL. MRtsz,G--t t T
• • Tz is T.T^' g pf R T I•N PROBABLY p�'N�' ._NOTIFICATION/k A-VER FORM
•
Name Of Individual Applying 'For Permit: K),,,,,k./16. 444).
Address Of Property: if OZs Lf i• 51
(Lot or Street #, Street or Road, ty .& 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 _
:Ids d J y 4 c k
Tf you have objections to what- i s beingronose
- -• a
p Paso write the
fl i vi s i nn of Coastal Management , 127 Cardinal Drive Extension,
Wilmington, North Carolina, '2R4-05 or ral l 910 -9R'-7900 within i 0
---------days of rPrPir)t of this -not-ire NO resnnnsP is rnnsi cierec9 th_e samo
as no objection_ if you have been notified by Certj fiec9 Mai l
WF IVER SECTION
.1 understand that .a pier, dock, -mooring .pilings, breakwater, -boat
-house or boat lift :must be set back a minimum distance of .1a ' -from
-my area of riparian access - Mess waived by me. (If you wis:a to
waive the setback, you 'must initial the appropriate blank below.. ).
/l V I do wish to waive the 15 ' setback requirement.
-I do -not wish to waive the .15 ' setback requir-ement-.
Y\f\t, C.AGLA-c--4%-- c=').D b /
Sign .N me .Date `• '
f Yl L cif co-t 4
Print •Na e
9 a - 3 0—o l 3 a
Telephone Number With Area Code
NORTH C AROLINA D`?M,r,— - of
ENVIRONMENT AND N.UURAL RZED.0 .S