Feldt

( t .4 : CERTIFICATION OF EXEMPTION 1/
hH
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 C *‘ n t.. d1 Phone Number 10 54+2_ -�?51
Address 14n, Gr ae r\s .5n r a t-r.e_e_.-i-
City 0 1 d-r r. li?,c`c c k State n)cL Zip
Project Location(County, State Road,Water Body, etc.) tom"r 4n c W.4 c k-- (I a v,n i 4-(2)( r e.e r 'ill I u St^cc e 4- t -t--1 old c IA .- PA A CIE -fry-)R
Type and Dimensions of Project rArx t:- ftNr1 c (on I C..0 IA c6.--r-\e-(, -i u rtone-.n ;()ENS
Sb\Q &J r I o k , 1 le i-.ci}-A-. R o w, b u l k ri }_o to 1 k- I••e-J1 d rvv u�' -
t r._,-1 e'_X r- e'r-i y r-f ()6 4 rI o 1 ei 1 Si--A-e-,, r _ i
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- f
sent of a CAMA official under the mistaken assumption that the Appli sjgna ure
development is exempted,will be in violation of the CAMA if there ///
is a subsequent determination that a permit was required for the
development. C A fficial's signature
The 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 "vl 11 .2000

•
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
. Na me Of Individual Applying For Permit: Jnl�2-�.i ,jJ7
Address-Of Property: P/C} a2 eels
/441ex) 8 ef4 e_ a1 ),) , -,..
(Lot or Street #, Street or Rclad, 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.
X -
I have no objections to this proposal.
•
If you have objections to what is beinc proposed , please write the
Division of Coastal Manacement. 127 Cardinal Drive Extension .
Wilmington . North Carolina , 28405 or call 910 395-3900 within 10
day of receipt of this notice . No response is considered the same
as no oblection if You have been notif1ed by Certified Mail
WAIVER SECTION -
I understand that a pier
houd, l dock, mooring pilings, breakwater, boat .
must be set back a minimum distance of 15'
from my area of riparian access unless waived b me. (If Y you wish
to waive the setback, you must initial the appropriate blank
below. )
i do wish to waive the 15 'setback requirement.
x I do not wish to waive the 15 'setback requirement.
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S1 ture (144e-4
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► ol3 it eoll u.S,,iu Date APrit`� e
amn
Telephone Number With Area Code H N R

MGF BUILDERS, INC.
125 LUMBERTON STREET
HOLDEN BEACH, NORTH CAROLINA 28462
[phone]
61t
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•
•
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER- FORM
. Name Of Individual Applying For Permit: e.7,--)0 LA7'
Address" Of Property: /l jQ ap.ee 5 `
Aleykel ( pl 14c �% �
(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
should beprovided with this letter.
I have no objections to this proposal.P _
If you have obiections to what is beinc proposed ,
Division of Coastalplease write the
Manacement . 127 Cardinal Drive Extension ,
Wilmi ncton . North Carolina
days of receipt of this28405 or call 910 395-3900 within 10
notice. No response is considered
as no obi ection if You have been notified the same by Certified
�ified Mail
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boat
house, lift must be set back a minimum distance '
from my area of riparian access unless waived b u: i5
to waive the setback, y me. (If you wish
below. )
you must initial the appropriate blank
I do wish to waive the 15 ' setback requirement.
I do not wish to waive the 15 'set' requirement.
requirement.
S • mat re
21L
L1-/ 3LW \ F- OGSE ) f ' •
Telephone "Number With Area Code11

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• MGF BUILDERS, INC.
125 LUMBERTON STREET
HOLDEN BEACH, NORTH CAROLINA 28462
[phone]
I
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90
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