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CERTIFICATION OF EXEMPTION
FROM REQUIRING A CAMA PERMIT '-;"PsS 1 ) c) (--i ?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 Vl�,,,0 1 1 A 1 1 Phone Number III) 72a-g3ac(w 1
Address 4'. 0 • .-- 3)( 30-1,9 e
City ,RA le. h State Ai C Zip,J'4 4,J
Project Location4County, State Road, Water Body, etc.) ?05- z, 3'''> 57 , 51,4 P P C:-f 1
Af1`Af Pp 11fAN v1/vet ( N14 I )5(Ol.,J C.1) •
Type and Dimensions of Project t:,.P10A A_ +=140‹.-r-J '-' ,0 Al RA rt,-1 1 et R,_,t,K+a-EA i-1
K (0„//��((�rc 1 �✓f/1 f (( (( ...�`n.s fiPc " I bPri • . � Lam; tli^) PPfinI ,l
42 ' 4 1 () 14 f'F,,[4/Y r r`/ .
The propose'd projecttobe focatedand'cbnstructec�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: )
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Any person who proceeds with a development without the con- . f. .,1,11
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 --�s. I
CAMA Official's signatu
development. /
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 lj — 0 — oa--
landowners certifying that they have no objections to the Expiration date
proposed work.
Attachment: 15 North Carolina Administrative Code 7K.0203
'EL :919-783-7642 Nov _i 01 8 ;52 No .UU2 F .02
\ lS()ti ()F ii()&ST&L M mi FN-r'
AD1. CENT RLP AS1 A N p12 0 N—MU E —EOR rw
Name Of Individual Applying For Pc-mit: i fN D E.(A, 5 4(.
Address Of Property: 73 O S T t{-1 K.0 ST, -) L C,► z
SJ2FCi;' Oki5C. CA0f AJC
(Lot or Street#, treet or Road, City & County)
hereby xrtify that I own property adjacent to the above-referenced property. The individual
applying for this peewit has described to'ttie as shown on the attached drawing the development
tbey ere proposing. A desotiption or drawing, with dimensions, should be provided with MIL'
lets, •
�N tr►P1.S I have no Oo ections to this proposal.
nti h�v nhl� inn►A�38Ls }?C1(I& �l�Y•CPrjnl� • hr�+:1::nn of S`n.akraet
7 1
tit r..I�.cla� • of th• rt.. J3iL1.G�flnSP 1C���1L�1� h SQL' &mint
Meer. rgifierlMall
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I uad=cand that a pier, dock, mooring pilings; breakwater, boat house, lift or sandbags must be
set back a minimum dicta a of 15' from my arm of riparian access unless waived by me. (If you
wish to waive the setba , you maLstinitial the appropriate blank below.)
'ru AL-5 `I` I do wish to waive the 15' setback requirement
I do t nt wish to waive the 15' setback requirement.
/PrintA ll*A6
te
a a-fie~- F., 1��c.11 G .w Name
97/7-rz :3 _ NCDENR
Telephone Number With Area Code koierw c.,k�-�,,,.ap.,.i o-
e.P VIJ,O.M5Mr...n Kauw., r+bw+nat:
It� :�1`�-rSJ-ra�tl Nov 1ti U1 1 ( : 15 No .005 P .05
\-,,, .. /
i
Name Of Individual Applying For Permit • •
Address Of Property:
(Lot air S reet 1, Street or Road, City& Comity)
I hereby certify that I own property adjacent to the above-referenced
applying for this permit has described to'iXie as shown an the a prawing the d Individual
they are Pr Ades uoa or drawing, attached drawing development
letter.
.
with diruceazloas, should be provided with thus
4I have ao objections to this proposal.
1"
NAITEIL SECTfQ
I end that a pier, dock, mooring piling; breakwater, boat house, lift or sand
not back a minimum of 15' from my area of riparian ace b must be
'wish to waive the setback, you must initial the appropriate blank.b s�awed by me. (If you
•
4)---
T do wish to waive the 15' setback requirement.
9 meat.
• I slut wish to waive the 15' scthatk requirement.
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41 .i. - Data ......._._ ___•--...p...J11,
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L&),J4/0 c 1 • 'TN qG AR.b
Print Name ,
.....aits22,....„._____, N.------.CDEN-16—mak
Telephone Number With Arent Cade +i+cho,p,. hotte,oR