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Home My WebLink AboutBeamon N:1/4. � II /� CERTIFICATION OF EXEMPTION P,S , 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 ,Y in an area of environmental concern pursuant to 15 NCAC Subchapter 7K.0203. Applicant Name . - t'\'Mf 5 ?iP,,fl tY•NUr-N Phone Number Address P • 0 • 13 U'( 1`4 V Z City )J o r}h + 11<e`- )r.J State }JCL Zip ')8(,51 Project Location (County, State Road,Water Body,etc.)A fit+r' -. Jtc k. C4>N..-I ' 0(, + JTC F' nS%T .n �r k Mr - Mcv-\,`J C Ar•P I Type and Dimensions of Project ;•-i \s c t.,_.trye--1 of itof\-‘;r,ci au c K- ►U` x I L-^ 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: ) Nv -\. MAdc.- (.. r\nr< I It) t p r u Posed c-lof,--krc\ Luc ti-- to nor,T fnuS* r.u-t fXcePd ' I -}-1�e_ e s-V-bt+ 51...( d I P,c-r he.-r\d I;r'c), 1_._k 5U LOT r l_.( Any person who proceeds with a development without the con- I '. '1 • ' , ( L 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 'irtl&QC)-- is a subsequent determination that a permit was required for the ^bY� development. 7CAMA icial's signature • 'Cot .�.UU U The applicant certifies by signing this exemption that (1)the ap- �E�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 i dew I(,p t .2 UUO me5 \-- eckcyv) (- &M \C.e6-1) �C `fiOc0 SUnSe� � euCh re�lacP -ck. rnv ' ` , ' DIVISION OF COASTAL MANAGEMENT ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM Name of Individual Applying For Permit: \_ Address of Property: \��-��>��-��[\1�-�......................._................._......... _______ T� -"~\ NC �4' �,8 L��L ��U __________ (Lot or Street #, Street or Ro(ad, 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 w ith this letter. I have no objectives to this proposal . If you have objections to what is being proposed, please write the Division of Coastal Management, 127 Cardinal Drive Extension, Wilmington, NC 28405 or call 910-395-3900 within 10 days of receipt of this notice. No response is considered the same as no objection if you have been notified by certified mail . .................................._________.................. ______.....____________........................._____________ WAIVER SECTION I understand that a pier , dock, mooring pilings, breakwater, boat house, lift or sandbags must be sat back a minimum distance of 15' from my area of riparian access unless waived by me. ( If you wish to waive the setback, you must initial the appropriate blank below. ) ___ I do wish to waive the 15' setback requirement. I do not wish to waive the 15' setback requirement . _..................................... _........................._........._...................... _ ...... ...... __ __ ........... _�______ Si t Date ---------------------------------------- Print Name � o�n� ___��-.�. �.-- 3'� n-. ______ _______________ Telephone Number with Area Code ' ' DIVISION OF COASTAL MANAGEMENT ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM Name of Individual Applying For Permit : ..... � ��/" �� Address of Property: ___'t� _\ -�� f��[_____- ___________ �J +� _____________________________ __OA &B (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 be provided with this letter. ............. I have no objectives to this proposal . If you have objections to what is being proposed, please write the Division of Coastal Management, 127 Cardinal Drive Extension, Wilmington, NO 28405 or call 910-395-3900 within 10 days of receipt of this notice. No response is considered the same as no objection if you have been notified by certified mail . ______________________________________________________________________ ______________________________________________________ ----- WAIVER SECTION I understand that a pier , dock, mooring pilings, breakwater, boat house, lift or sandbags must be sat back a minimum distance of 15' from my area of riparian access unless waived by me. ( If you wish to waive the setback , you must initial the appropriate blank below. ) I do wish to waive the 15' setback requirement. I do not wish to waive the 15' setback requirement. _____ ________________________________________________________________ ____________ ___________________ _______ ___________________ 0() 'v / - __��___________________________�Da�__ Signat", e `e A / / __n_ ,J��c/ l___---_/^_--_-`-____________ Prit �ame D ____ _ ____ ---- Telephone Number with Area Code • • nl r O -0 n o 3 � 16