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.1\- CERTIFICATION OF EXEMPTION ,.
v
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. r�
Applicant Name )ti V i 0 { C�" i N-y Phone Number ��! C�. �
Address t '' p.0. 1�j 0 ( D�
City i tv` State 0 f< Zip 3 3_Sy
Project Location(County, State Road, Water Body, etc.) 0 A - f 5 U U t
--N c, Sri- , vct ADS E r Q N V 5 titi� I I -eti n pK e.-) .
Type and Dimensions of Project /h1 /,(L/4 r f-e.c./ 0 , 'H(Arike-f.) L.4 4 tbd,t) 04'
' " /, r74� S
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 with ut the con- N� f
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
development. CAMA Official's` i n tuts 2
The applicant certifies by signing this exemption that (1)the ap- j '�
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 _

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DIRECTIONS FOR OBT_4I 7NG A C-4111,4, GENERAL
PERMIT for a B ULKHE_4.D
To obtain authorization to construct a bulkhead, you must submit the following items0
Ofricer: to your C.4MA Perini
1. Signatures of no objection to the bulkhead, from both adjacent riparian
property owners.
Fill out the attached forms, complete with drawing the
proposed bullhead, and haveyour neighbors of
hbors sign and date
in the appropriate place.
tar If your neighbor will not sign the form., or lives out of
town, you may send the form to him, certified mail/re turn
receipt, and 10 days after their date of receipt (which
listed on the green cards returned to
you by the ost
Office) the permit can be issued, even if no response hasbeen received.
2. You must also include a drawing of the proposed bulkhead, which includes
the following information.
`a' Your name and project address
r Names of adjacent property owners
Width of property and name of the waterbody, and the
approximate location of the proposed structure, noting that
the exact location will be staked by a representative from
the Division of Coastal Management.
Any marsh grass border along the shoreline
Once you have this Formation you should contact your CAMA permit officer
meet you on the property and evaluateyour request. o --r and Q�
When you receive your `it to appointment d building
. ....inspector to obtain a building � ��'
permit. This authorization is only valid for 90 daP��n ct your Prmi
Officer if for some reason you cannot complete the construction within this timeperiod. '4 pest
days, contact your C
Officer will inspect the completed bulkhead to assure compliance with the submitte dra i a and CAMA conditions
of the permit -awing all conditions

S_
DIVISION Or COASTAL MANAGEM
EATT RIPARIAN PROPERTY O _NT
ADJAC
OWNER, NOTFICP.TIONITvpIvEg FORM
Name Of Individual P_palying For Permit: ; ‘ I • . - -
Address _ �
��
Of Property: \ C, ', M
(Lot or treet r, Stree 1 t or Road, �l � .
City & County)
I hereby certify that I own
referenced pY'oper1 property adjacent to the
described to as shown on the individual
attached aw; the above-
applying for this permit has
they are proposing. A description or dra •drawing development
should be provided with this le ��q• with dimensions,
letter.
I have no objections to this proposal.
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you have obie�- ;
Ifvi `tions to what is being proposed ,
Division of Coastal Management, please w�'ite the
Wi 1minQtor, , North Carolina . 127 Cardinal Drive Extension .
days n or Dt hf thisL • 28405 or call 910 395-30
as no f rec notice_ No response is consider0 wthe s 10
_tion if you have been ed the same
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_n notified by Certified M ; l
SvAI ER SECTION
I hDLIld2rstcIld that a pier, dock, mooring
�_OS_ 1; f - mL`5 5== pilings, br c=iidct=r, boat
be back a minimum •
f waive
my V area_ofsri riparian acoes5 unless waived vc (Iyou of i s i
below. ) _ `h aback, you must initial d by me. (I= wish
n1�icl the appropriate blank
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/ I do wish to waive the ?S'setback re uirement_
s�1eL_ I do not
wish to waive the ?5'se tba-k reau r_en t.
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tii�atL'rz _
/ Date
Drina Name A74
TelephoneNumber t D _ ��[�
[
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With Area Code
t

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ADJACENT TY OF7NERNOTIF DIVISI MANAGEMENT
ON OF COASTAL MA --
RIPARIAN PROPERTY` ICP.TIONIAAIy FOR*
Name Of Individual Applying For _Permit:
Address Of Property. 1C-,
(Lot or Street #, Street or R 1C''� e
Road, City & County)
I hereby certifyve-y that I own property
Proper�y. The Y adjacent to the
described to omep as . individual applying for this at has
they are shown on the attached drawing Permit has
proposing. A description or drawing, the development
should be: provided with this letter.
with
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dimensions,
I have no objections to this proposal.
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If you have objections to what
Division Coastal M- is being Proposed .
PleaseD•
ivision
anaaement . i27 Cardinal rive Write th
on .North Carolina . 28405 or cep Drive _
Wave n receipt of this call 91-0 E `- ns; on .
asdays
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no f receipt
-s notice. No response 395-3900 within 10
pion i f You have beo L . is c-ti fi e,-e3 the same
n no�1fied by Certif;ed Mail
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WAIVER SECTION
I understand that a Pier,
hound, lift , dock, mooring pilings
from my area r must be set back a , es, boat
towaiveC p'�' an access minim m distance the setback, s waived by me. of �.
below. ) you must initial (If you wish
the approPri e`s blank
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-------- I do wish to waive the 1 j'se tba ck requ =m=nt.
I do not. wish sh to waive the 1 j'Setback reau rz"ment.
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Sigratur` Date
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Pr-n� N�m� . '
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Telo Area Chone Number With A l V
- - Code