Smith (20)

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CERTIFICATION OF EXEMPTION
FROM REQUIRING A CAMA PERMIT
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 r . SM, /e T . w At't"-r S Phone r,iiii e hri —
Address I (-t. 1 _MiA.cctle Scru.,,. & 1City Lkll ( 1..)vo, iState C. Zip ..%.c}. I 1
Project Location(Co nty, St Road,Water Body, etc.) :,... , c .. _ • .' _
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Type and Dimensions of Project --A--i U ifVb2.) fit.e.„1---
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.
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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 Applicant's signature 1
development is exempted,will be in violation of the CAMA if there
is a subsequent determination that a permit was required for the :Pi
a
develo ment. CAMA Officiaii ure
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The applicant certifies by signing this exemption that (1)the ap- --` ,sieO
Issuing date
plicant has read and will abide by the conditions of this exemp- S_ '` 'OD
tion,and(2)a written statement has been obtained from adjacent b

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= A_ Coastal Earthworks, Inc. 1...,_
iYO MUDOER
3 1955 Middle Sound Loop Road • Wilmington, NC 28405 • Phone: [phone] • Fax: [phone]
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DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name Of Individual Applying For Permit: r
044
PS
Address Of Property: J o { _� ;dc�e nn �
�LtL�E J i4-d N 7 C 281. C'S
(Lot or St et t, Street or Road, City & County)
spy '� rPcA,
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 .
If you have objections to what is being proposed please write the
Division of Coastal Manacement, 127 Cardinal Drive Extension
Wilmington North Carolina 28405 or call 910 395-3900 within 10
days of receipt of this notice. No response is considered the same
as no ob 'ection if you have been notified by Certified Mail
WAIVER SECTION
I understand—that a pier, dock, mooring
house, lift or s-a-ndbags must be set back alminimumb distance rofb15 '
from my area of ripari-an, access unless waived by me. (If you wish
to waive the setback, ybu .>.must initial the ap
propriate ppropriate blank
I do wish to waive the 15 'setback--r_eauirement.
I do not wish to waive the 15 'setback requirement.
Signature, S I r- 1 Date
ter. •'�. .�JG -' r A . APrint Name
Telephcne Number With Area Code 1--I N R

DIVISION OF COASTAI, MANAGEMENT
4DJ 4CENT RIPARIAN PROPERTY OWIsiT,R_NOTIFICAnoNjwATVER FORM
Name Of Individual Applying For Permit: `Tong.
tkick.s"-Zss
Address Of Property: j cr S j 0l.c-l� l e SJ cA,toI 4 ^ ?c r
(A).'1p, ,f7tro., / A).C ; 254 if
(Lot or Street, 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 n'ie as shown on the attached drawing the development
they are proposing. A description or drawing, with dimensions, should be provided with this
letter.
.2( I have no objections to this proposal.
If you have objections to what is being proposed please write the Division of Coastal
Management, 127 North Cardinal Drive, Wilmington, North Carolina 2R405 or call 910 395-
3900 within 10 days of receipt of this notice_ No response is_considered the same as no objection
if you have been notified by Certified Mail
5c lr
WAIVER SECTION
I understand that a .'- dork, mooring pilings, breakwater, boat house or sandbags must be
set back a minimum d- s. 15' from my area of riparian s ess waived by me. (If you
wish to waive the setback, you se 'i itial the appro. '. 'lank below.)
o wish to waive the 15' set,: requirement.
I no not wish to waive the 15' setback requiremen
A7k2S ?JO AIM
Signature Da
Print Name
9W7 NCDENR
Telephone Number With Area Code NORTH CAROUNA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES