Paker

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 ‘-\ \ 1 -P-4' Phone Number ' 4" Li I
Address 4> v t3vx 3 2
City ..,`, \ State Ndj zip & 4(Z
Project Location (County, State Roa , Water Body, etc.) u n.,w•,e K-- , o u n ]b
Ik o n r oe -�-e-e-t c � kv e c Mom- M n d� C�n-r e \
Type and Dimensions of Project Sp' low Ik..,\ne inch \frr du)Et•e-d 0c A I1 be-1- I ere,dS , nFL.J
8' x Il, f\oPiA, nc.1 do c .
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- ‘4__a_4r1J� w4'1 G/1'/
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 l/ Qis a subsequent determination that a permit was required for the
development. CAMA Official's signature
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 !v 0-\) . ' 1 0�00 0
_� +1,.,, ,h,,,,, haua no obiections to the Expiration date

T
;IVISIN_ OF CO} $TkL MANS A N O W TVr FORS
ADJACENT RIPARIAN , PRQD RT' Ow ER NO F
Name Of Individual Applying For pgrMit :
()(11 -
Address Of Prcpert'1 : / 4 73 -7)707-Vice. :i
C r, , NL-.
( Lot or Street fi , Street or Road , City & County)
I hereby certify that I own property adjacent to the above-
referenced property . The individual applying for this permit has
described to me as shown on the attached drawing the development
they are proposing . A description or drawing , with dimensions ,
should be provided with this letter .
I have no objections to this proposal .
ctior,s to wt;la s b- n
Di��is:rn o Coastal M.onac;eaert . 12.7 din Or ' v Extension .
wa lmingtcn. .Nor h Carolina . 28405 os call g10 395-3900 within 10.
.1Ays of re int o hi s notice, No + nse is c.cnsidered the sa-t�A
. o o ection if tMn n2 f d by Ceryif i d Mail
WAIVER JECTION
I understand that a pier , dock , mooring pilings , breakwater , boat
house , lift or sar.dbags must be set back a minimum distance of 15 '
.rom my area of riparian access unless waived by me . ( If you wish
to waive the setbac), , you mus_; initial the appropriate blan
below . )
I do wish to waive the 15 ' sgtback requirement.
I go not wish to waive the 15 ' setback requirement .
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Sigyturel Da
Pri Name
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�� �1 74 r 7$ Z Code iFt
Telephone Number With Area

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JUL-21-Qe 03:24 PM Varnamc Ducky + Bulkhead 910 $42 762e p_ gg
• D v S CO T
fifsu£ T AIPARYAN PROF I OWNER NOTIFICATION/eAIVF,_'QRM
Name Of Individual Applying For Permit: AThedirf PaAALY
Address Of Property: 11 , 7a' 4 73 -Munroe- :3 '.
Q 5 I NC �. .
(Lot 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 proposing. .'A description or drawing,, with. dimensions, . ,
•
shoul• be •rovided with this letter , .
44 Y have no objections to this proposal.1!'
If you have yob jectionA to wh,atjs being p 9oos_ed, o_kpase write the
Division of Coa ana a , c v EXtenSiOn..
Wilmington. North''Caro:li; a ' 2$4Q5 4Z; T4910 '395.3900 w3.tluo j..4
�SY.�ft,�i�ec�r�,�� YQu�t1�veCbeenNo reSpoiinQS.�fi�s3 e.,is -�I�s,idg�'ed the''sam4
by Certified Mail
WASVER SECTION • A,
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I understand that a pier : dock, mooring pilings, breakwater, boat
I: .` .., '. wai miniX m distance .of, .15'
house, lift or sandbags mks„�� be set back, a,
from my area of riparian access unless ved b•• me. (If you'w3.'sh
to waive the setback, you must initial the appropriate blank
below. ) .
0 J , „x, do wish ;to waive the, :i5'setbaCk requirement.
, •:do not Wish to waive the 15rsetbaok requirement .
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