Batts

sY
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 •1AME-S 1-kOWARc> 1.- A-k-tyc Phone Number S.>i- 05 J -I-
Address t - 1 e L,,a 4 i Q `,1-e _
City f J State f c Zip j 14/`/S
Project Location (County, State Road,Water Body, etc.) L u-F i'3 S.�f 'r L�AA,t,ni DR, v-e
`�\I PCrJpFk C ADSAC E rvt.. ,- w,Anr J U,A L
Type and Dimensions of Project IR.‘\/Pc C P PR- bpi X 70 pi 4-1-ti 2 V►^ - Ss ' )(a U
--x No /�'v�R-4" --r _, C //Al l�R 0r /$44 I( Re ��✓e 2 ✓VA R S H
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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- V lir� .,lift „ tri
sent of a CAMA official under the mistaken assumption that the Applicant's sign ture
development is exempted,will be in violation of the CAMA if there
is a subsequent determination that a permit was required for the
development. A Molars signature
The applicant certifies by signing this exemption that (1)the ap- i -2- i/- oU
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 /0 -// —QU

MEAN HIGH
WATER LINE CURVE DELTA RADIUS ARC CHORD TANGENT CHORD BRG
Cl 50'24'47' 40.00 35. 19 34.07 18.83 S 89'31'57' W
TOPSAIL SOUND
N 87'31' 18' E _
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(,,—/....
r C'). A D.(Zander)GUY,JR.,MAYOR
NELVA R.ALBURY,COUNCIL MEMBER
Q DEXTER BLIZZARD,COUNCIL MEMBER
v DONALD R.HELMS,COUNCIL MEMBER
�� UHF C _ TY DONALD H.LUTHER,COUNCIL MEMBER
O WOcol? DOUGLAS C.MEDLIN,COUNCIL MEMBER
NORTH CAROLINA 2 8 4 4 5
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/UNCOVERED BOAT LIFT)
I hereby certify that I own property adjacent tog f1 (f . 4gytl)A r-'d jay fl ► l . 's
LTV I,, LA
(Name of Property Owner)
Lproperty located at 13 1.Asl S n 4 t 1,A 7- ri u - ,
(Lot, Block, Road, e .)
orr+05,ZS A - c1. -lc , in U rc- Ci+ , N.C.
,V_ (Waterbody) (Town an /or County)
He has described to me, as shown below, the development he is proposing at that
location, and, I have no objections to his proposal. I understand that a pier/uncovered boat lift
must be set back a minimum distance of fifteen feet (15') from my area of riparian access unless
waived by me.
I do not wish to waive the setback requirement.
iI do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
Rrl v .---t,,),- )01 •Ii• • zi-D_ 10Q_
P....-4.1.4_12
ignature
j 1 w"rv• Pi-erC e
Print or Type Name
-72X' r c 7
Telephone Number
Date: to — 2 6 - a 6

GJar 1
C��
�sova�R `- A.D.(Zander)GUY,JR.,MAYOR
NELVA R.ALBURY,COUNCIL MEMBER
ZI DEXTER BUZZARD,COUNCIL MEMBER
� UHF C I TY DONALD R.HELMS,COUNCIL MEMBER
t l DONALD H.LUTHER,COUNCIL MEMBER
�� H�O R•T H LQQ� DOUGLAS C.MEDLIN,COUNCIL MEMBER
NORTH CAROLINA 2 8 4 4 5
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/UNCOVERED BOAT LIFT)
I hereby certify that I own property adjacent to---) A mks 's
C � L_A
(Name of Property Owner)
property located at LO 6cl� S n 1 t\
(Lot, Block, Road, etc.)
on—hoeS % N.C.
(Waterbody) (Town and/ County)
He has described to me, as shown below, the development he is proposing at that
location, and, I have no objections to his proposal. I understand that a pier/uncovered boat lift
must be set back a minimum distance of fifteen feet (15') from my area of riparian access unless
waived by me.
I do not wish to waive the setback requirement.
X I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
Y t U t (4�7 J 6
Signature
(6nA1ct_ J Tmv>�,
Print or Type Name
Telephone Number
Date: \')U11 I t C
_;., •