Ormond

CERTIFICATION OF EXEMPTION
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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 �R 0 .1 • Y✓\- K--' },•-A-( 9 Phone Number
Address 1 1 `) YlsA t\iU\. A M P-
City -,,y,Aer ►..,q*v?z- State Ai C Zip (o
Project Location(6bunty, State Road, Water Body, etc.) -- FA-I --•ALQ-i -W1A1 r vJ � R
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Type and Dimensions of Project 3v.\\4 1-9-4 D 0 C 0 i eR"`c a a ' GA ,.. __(.1/4.Agi)
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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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I P) IIICAr3L A
Any person who proceeds with a development without the con- v �`�-
sent of a CAMA official under the mistaken assumption that the Applicant's sign ture
development is exempted,will be in violation of the CAMA if there
is a subsequent determination that a permit was required for the
development. CAMAOfficial'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- G
tion,and(2)a written statement has been obtained from adjacent 1 - I l- J 1

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER- FORM
Name Of Individual Applying For Permit: DC JOhw Qr ojxi
Address Of Property: //3 1,poIi4 Or
/�,f,ik'� , r?
(Lot or Street' #, Street br 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 ovided with this letter.Pc
I have no objections to this proposal .
If you have objections to what is being proposed, please write the
Division of Coastal Management, 127 Cardinal Drive Extension,
Wilminaton, North Carolina. 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
_
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W• R SECTION
I understand tha a pier, dock, •� pilings, bre ater, boat
house, lift or sand •. •s mus •e set ba a minim j.stance of 15'
from area of riparia . • cess unless wai' - y" me. (If you�,r.
to wai ' - the setba , you ust init . - appropria a—blank
below. )
I • - wis�• aive the 15 - •.ck requireme t.
I d•t.doue ' h to waive t. 15'se 'back requirement.
OC:2 - - i 1 I A
Si ature Dabe ` )� •
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Print Name ______ r
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Telephone Number With Area Code