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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 ,Le Di A( �r N K U Phone Number 7 G' ) 4,70— .,)O
Address el 31C V 3,,n�'t U4n. A'
City ' " ° State L Zip ,U(/('�
Project Location (County, State Road, Water Body, etc.) �l 13 (. '�'l--.h,vV-- ' ) ti r
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Type and Dimensions of Project '?t7Nini,r.I - (iv,4 1/ LAN1 ,�iPi t)/ G4� F/ALAS (1�3
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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- 11111► // 0 ,C r
sent of a CAMA official under the mistaken assumption that the Applic- ' signa u e /�
development is exempted,will be in violation of the CAMA if there
is a subsequent determination that a permit was required for the -. 21,4-
development. CAMA Official's9signature
The applicant certifies by signing this exemption that (1)the ap- 1 �,� �v
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 /D - U/-0°

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DIRECTIONS FOR OBTAINING A CAMA GENERAL
PERMIT for a BULKHEAD
To obtain authorization to construct a bulkhead, you must submit the following items to your CAMA Permit
Officer:
1. Signatures of no objection to the bulkhead, from both adjacent riparian
property owners.
Fill out the attached forms, complete with drawing of the
proposed bulkhead, and have your neighbors sign and date
in the appropriate place.
If your neighbor will not sign the form, or lives out of
town, you may send the form to him, certified mail/return
receipt, and 10 days after their date of receipt (which is
listed on the green cards returned to you by the Post
Office) the permit can be issued, even if no response has
been received.
2. You must also include a drawing of the proposed bulkhead, which includes
the following information:
gar Your name and project address
gar Names of adjacent property owners
gar 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.
oar Any marsh grass border along the shoreline
Once you have this information you should contact your CAMA permit officer and arrange an appointment to
meet you on the property and evaluate your request. When you receive your permit, take it to your building
inspector to obtain a building permit. This authorization is only valid for 90 days, contact your CAMA Permit
Officer if for some reason you cannot complete the construction within this time period. The CAMA Permit
Officer will inspect the completed bulkhead to assure compliance with the submitted drawing and all conditions
of the permit.

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER- FORM
Name Of Individual Applying For Permit: ,(1 ..... .1),,loif6-A)4
Address Of Property: 238�6 \l o y31ti= / o
(Lot or Street #, Street or Road, City & Count
y)
ty)
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,
shou d e provided with this letter.
I have no objections to this
proposal.
If you have objections to what is being
proposed write th
Division of Coastal Management, 127 Cardinal ,
ard na 1� Driveplea�2E tension,
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 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. )
(
/1111
I do wish to waive the 15'setback requirement.
I do not wish to waive the 15'setback requirement.
9/r/dD
Sig at re
DateA •
Print ame / tiucioy
�YIr-z _
TelephonlNumber With Area Code
�EHNR

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION WAIVER_ FORM
Name Of Individual Applying For Permit: !�(�� C 4/f5,' )
Address Of Pro erty: 73S3a. �vpu 4-71l /)�
r (^j %�6'� _ - IA/
(Lot c��- - �'� �a��]
Gc 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 p oposing. A description or drawin
should be rovided with this letter, g' with dimensions,
I' have no objections to this proposal.
•
If you have objections to what is beina Proposed please write
the
Division of Coastal Management 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 pilings, breakwater, boat
must
back
from my area of riparian access unless wai ednbyume. (m If
of you
i15
s '
h
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.
Signs e l 61t)
a e
Print Name
Telephone Number With Area Code H NI R