Carter (4)

i
7y—) CERTIFICATION OF EXEMPTION
FROM REQUIRING A CAMA PERMIT
as authorized by the State of North Carolina,
I✓-'y 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 i---,And( Gg4-tiit (/.„ nc 'L C_ Phone Number i r v'j 35S- 5-06.
Address i d L.,131,.1 (Awl
City , !,•.,- State A,. C Zip .)et7/0 5
Project Location(County, State Road, Water Body, etc.) itv.A-'Su n4 j - h u bor S4 .,,,‘( iN
l o-i 44 '1,4-tP...-' -iv S)y T. . A. bun) /1 v -
Type and Dimensions of Project rr .._,6,--;,, -6,A t ra4) (...1^,r._)viiit d r t/A-GGc-/ '1 y,,rvs--1
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: )
4 C,*W`A aI LA-VS
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Any person who proceeds with a development without the con- �\ �.,.
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 '`-.' ' i--7aT
development. CAMA Official's signature
The applicant certifies by signing this exemption that (1)the ap- ` a _ 0
plicant has read and will abide by the conditions of this exemp—
tion,and(2)a written statement has been obtained from adjacent 3 - DJ - ()u

DI"v-' cTON
D`7j'C NT RIPARIAN Or COA T__L N�•NAC.i✓ENT
PROPERTY OWNER NOTIFICATION/WA
. C=R. rORM
NanE' Of individual Applying For Permit:
k
Address
C A �fZ
Of 'Property;
•
•
(Lot- or Street i5, Street - .
or Road, City & County)
•
•
I hereby 'certify
t!lct I
referenced property.• The own property adjacent'�� to the at ha=
- described individual applying -
ed to m=_ as shown on the ing for this
they r_ P_ de 1 attached drawing thepermit has
are prDD05i•nc7.
should d be provided With this
r °n or drawing, with dEVE�ODI'ile*'it
�_
letter. dilaension=
i.
i have no objections to this proposal.
If VOU ticVEpblEr'tiOnS towhat
k;i on ofler-Coastal- Mt ` is b 'na pr0005- ,
Divday non Carolina .
E-:� i27 cardinalp e-SE Wri tc 0n .
Nor-'
c O_ receipt p= this 1, 28405 or call oil. 3 9- VE Ew:th within
o1
a- no f 1-er-t;on if v notice. No response is "'-3°00 wi th;n i �
you have been notified _S COnei der2j the aiue
by Ce,-tifi�d Mail
WAIVER SECTION
ho •
use, l i `-' CT- sandbags
pier, dock, nooring vi1 i
hour ;V =-n= of andbas In st _be c h._ - -:IQS, }Jdistance boat
to ei riparran aC:c5= _ minimum m distance -
w V tn= setback, unless c=5 waived by La nC` °_ l r
below. ) - you must initial r" (Ifyou i c;
the w--
apprOpr-=te hl `rii.
•
•
T do wish
to waive he 1 G 'se Check re_u i rement.
-� T do not
wish to waive the 15 'setback rECui ersm '
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