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-Y- CERTIFICATION OF EXEMPTION
..,H ) 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 Nam /Yl /C., 4 y e ( 1,J n -e r4/ ( Phone Number
Address Ji p
City / -� A-- State T ,, a I N ti Zip _c Project Location (County, State Road, Water Body, etc. AO o� !4 c ti* 0'- -i --
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Type nd Dimensions of Project f
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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- 1,. -. O �---• .---r" - ). — 1' )b t' '
sent of a CAMA official under the mistaken assumption that the Applican's signature
development is exempted,will be in violation of the CAMA if there i
is a subsequent determination that a permit was required for the PAM a •
development. 6,-/ctk _.---
LAMA icial's signature
The applicant certifies by signing this exemption that (1)the ap- / ��-
plicant has read and will abide by the conditions of this exemp—
tion,and(2)a written statement has been obtained from adjacent `U .2 () 0 0 0

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6% 4/2000 16: 15 910-2781711
35
f TOWN OF OAK ISLAND ° aoo6-(PAGE 01
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DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name Of Individual Applying For Permit: freA0 '12./P /,`"--
Address 'Of Property: 4 2 o 2 G ti . 45, A- ,
(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 me as shown on the attached drawing the: development
they are pr posing. A description or drawing, with dimensions,
should b rovided with this letter.
I have no objections to this proposal.
;f you have objections to what is being proposed, please write the
Division of Coastal Management . 127 Cardinal Drive Extension,
Wilmington North Carona 28405 or call 910 395-3900 within 10
days of recea.pt of this notice, No response is considered the same
as no objection if you have been notified by certified Mail
WAIVER SECTION -
I understand that a pier, dock, mooring pilings, breakwater, boat
house, lift . 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 do not wish to waive the 15 'setback requirement.
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Telephone Number With Area Code