Bullard (3)

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
I -- in an area of environmental concern pursuant to 15 NCAC Subchapter 7K .0203.
Applicant Name J, r, \.`_:,.\\04t,» ' t o -T'c t ‘\ )u"' Phone Number 3.) Si— W /
Address (4 .> A x0(A rv. AV Q
City ;,_ ; ( fv State C Zip, 3 kWi
Project Location (County, State Road, Water Body, etc.) cAv--P A Ce"" pS44 ( Sow\.r) /lekc-tp C.o
Type and Dimensins f Project /} ,0,7 t v f,d
4A ' U i . s`/ti-y 4 ,)4, / -? - ,A,(/
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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.
SKETCH (SCALE: / '_ >U ' )
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Any person who proceeds with a development without the con- �Z , �t/� ' / c, � 4-
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 `"')a- 1 - L
development. CAMA Official's signa ure
The applicant certifies by signing this exemption that (1)the ap- _i_ 0,0
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 /o) -/ - 0 3

It. 1
ADJACENT RIPARIAN
OF COASTAL MANAGEMENT
ARIA_N PROPERTY OWN-
NOTIFICATION/WAIVER- FORM
Name Of Individual Applying For Permit:
1
P ZC
Address Of Property:
(Lot or Street ff Street or Road, City & County)
I hereby certify that
ref Era I own property adjacent to
need property. The individualme applying the above-
des are the attached Ying for this permit has
should be.pr�oposing. A description or drawing,drawing the development
p vided with this letter. with
•
dimensions,
Wave no cti
ob 'e� .
7 ons to this proposal.
•
If you have objections
Division of Co_ to what is
=stag being proposed .
Wilmington 1 Management . 127 Cardinal Dive write
• North Carolina . Drive 1 `e the
days of receipt of to 28a0S or call 91.0 9 Extens'on`
no f roc r is notice. No resoonse 3'S-3900 within to
as tion � � you
have been notified by s considereded the same
•
Mail
WAIVER SECTION
1 understand that
house, lift
` a Pier, dock, moor
from my area - must be set backg a minimum
distanced
of riparian act a �+; ; boat
tor V_ theripaccess unless bywaived
dnyL2m distance you� 15'
waive
below. ) setback, you must initial the me. (If wish
`- appropriate blank
I do wish to _
waive the 15 'setpack r`guir=mint.
do wish to waive the 15 'setback reouire
-- meat.
S i gr.ELur E -- d6)
Print IY6.- e- �1 44.4f ( Dc ie
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Telephone Number With Area Code -m •
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.P..
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• ► DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PRDPERTY O -
RNER NOTIrICATION/WAic?R FORM
Name Of Individual Applying For Permit:
Address Of Property:
,
(Lot or Street r, Street or
Road, City & County)
I hereby certify -
that I own property ad
jp l ing for this permit has
acent to the
described to as shown on the attached drawing above-
referenced property. The individual a
they
yare proposing. A description or drawing the development
d be provided with this letter, , with dimensions,
•
I have no objections to this proposal.
•
If you have ob-iec tions to what is bei
Division of Coastal Manacrem= nQ proposed , please write
Wilmington . Nor- _nt. 127 Cardinal Drive the
days n rece; • `h Carolina . 28405 or call 910 39 - 9 Extension .
receipt of this notice. No response is considered within to
as no obiection if you have been ed the same
_n notified by Certified Mail
HAIVR SECTION .
I understand that I house, lift a pier,„ dock, mooring pilings, breakwater, beat
•
hous mV a,-ea of risaricI1mas�est be e sett ack a minimum distance of 15'
to waive the unless waived by me. (If you wish
setback, you must i
below. )
initial the appropriate blank
T do wi=h to waivetie lS ' -
setback requirement.
I do not wish to waive the 1S'Setback requirement.
r tu_e " .
Date
_ r .nt -mo A
' s
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To_ Wit eph ►4
e umber 1 t Area Code