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CERTIFICATION OF EXEMPTION \.","
FROM REQUIRING A CAMA PERMIT p 1 p v31 t "- 2
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 L IC-iA--,- cr" ` . C-1A,f k — Phone Number b4J ib - a j 73
Address 40 (c 'f'i( p, p Ft k 0
City Fr ! r,r- t • `.- State G Zip c Z
Project Location (County, State Road,Water Body, etc.) ec u r\5 W 1 CK- ( ur\ LuT- J U
. f t I .0.r, '- 5 �-r-<: 0 c e-f -a-5 t c..� 13 e-r�c k , M►g- . tr\4 cd b C*1 A l
Type and Dimensions of Project ,�) b(A1 C'l - U' L.UT - (0-?) e^/'U S o r\
S A r rr,�"t' N' ft`c-d 6 ts+tx r ic ()(\ lAJ h (\ r. ,A ; tj
fU D u t r, 4- P , b A c t'. -s Lv i-e^r-
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: N()_, )
\r_ M 1\d€- --r 'A '_
I Rnt
fie. )* door _:o -73 LPur r.ot, rc
Rc f\-,.1 Lo7
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 ,},_ yy y�
is a subsequent determination that a permit was required for the ! _ � �" �i
development. CAMA Official's signature j
('\)(56. 114 aUUU
The applicant certifies by signing this exemption that (1)the ap- 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 C_.' i 0,^r-4, 0-1 \ 9 f a 00 i

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION WAIVER. FORM
Name Of Individual Applying For Permit: L�� j-,rjh dog/
2K
Address Of Property: >-,o7/ Q `//0.-/-)A-1. '66)-1) S?/ .
eaa T Go / c/h 5oric
(Lot or Street #, Street or Road, City County)
& Cou 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,
should he provided with this letter.
I have no objections to ;this proposal.
•
you have objections to what is beina probosed pleas
Division of Coastal Manaaement 1— - e write one
wilminQton North Carolina , 127 Cardinal Drive Extension
days of receipt of this notice. 4 No estionseor call910 is cons deed thelsame
as no ob1ection if You have been notified by Certified Mail
WAIVER SECTION --�
I unde_z-_ ' -nd that a ier,
house 1if p , dock, mooring pil ' s, breakwatr, boat
' must be set bac minimum distance of 15'
from my area of arian access u
s waived by me. (If you wish
to waive the setbac
below. )
u initial the appropriate blank
do wish to waive the 15'setba , e e
I do not wish to waive the 15 'setback reouirement.
Sig:n tu_
_I ?h 1 ate'
Print Name L c=�/ �� A . A
EDiHNR
Telephone Number With Area Code
9/d — //9- a/73 _r �h

• •
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION WAIVER- FORM
Name Of Individual Applying For Permit:
LE-
Address Of Property: Sc
• (Lot or Street t, Street or Road, City
County)
I hereby certify that I own property
referenced property. The individual appladjacent to the above-
ying
described to me as shown on the attached drawing for this the d evelot has
they are proposing. A description or drawing, with dimensions,opo
should be provided with this letter. nt
�lI have no objections to this
proposal.
•
•
If you have objections to what is being proposed , pl
Division of Coastal Management ease write the
Wilmington . North Carolina 127 Cardinal Drive Extension
• days of receipt of this notice8405 or call 910 395-3900 within 10
as no ob 'ection if you have been
response is considered the same
�n notified by Certified Mail
WAIVER SECTION
I ier understand that a
hound lift p , dock, mooring pilings, breakwater, boat
from m arta must be set back a minimum distance of 15'
Y of riparian access unless waived by me.
to waive the setback, appropriate blank
ou
below. ) you must initial the
I do wish to waive the 15 'setback requirement.
I do not wish to waive the 15'setback requirement.
•
Signature
Date
Print Name
Telephone Number With Area e
Code R
IA 7/0 s-7 --3 S a9