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C 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 -}-{ l 1 Qk1 OS C/ E ' t, f�N'f N ER Phone Number ?_.5� 3a6oa1
Address 7 of NT ( Pt
City IAA.) ri' -t S V�Q.2 4 State -: C , Zip 2
Project Location(Cit , State Road,Water Body tc.) S � -; 0 �1. , Ao' `i`r��-
Y-'m o-t s C- NI t ( . ev-ar '� , v
Type and Dimensions of Project 1 r
tI.R 2 ® F tSTth16
The proposed project to be located and constructed as described This cn-tification 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 .020$. 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- / ��
sent of a CAMA official under the mistaken assumption that the Applicann' ure
development is exempted,will be in violation of the CAMA if there
is a subsequent determination that a permit was required for the C5 Cv`-"
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development. CAMA Offi i l's signature
the `4-1 -9C1
The applicant certifies by signing this exemption that (1) ap- Issuing date
plicant has read and will abide by the conditions of this., exemp-
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PaiePhrg Wrightsville Beach,NC 28480
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DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION & WAIVER FORM
Name of individual applying for permit // 1 t/ �1 ti'
Address of property 6'4� fi*--4C `,Jri z'ye S fr ,ciL
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 of notification.
Please initial below if you have no objections.
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, Wilmington, N. C. 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 p - dock, mooring pilings, breakwater • house,lift or
sandbags must be set bac . • inimum of 15' from - ea of riparian access
unless waived by me.(If you wish • aive the - •ack, you must initial the
appropriate blank below.)
I DO wish to w-., - the 15' setback requir n ;
I i e 'OT wish to waive the 15' setback requirement.
/f CI*? , ' Signature & Date
in"?2 CYLhL4.-; Print Name
2s— 3d/7 Telephone Number w/ Area Code
PLEASE SIGN AND RETURN TO; F&S Marine Contractors,inc.
P.O. Box 868
Wrightsville Beach, N.C. 28480
Phone/Fax [phone]

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION & WAIVER FORM
Name of individual applying for permit /1 ne /.j/- 0`'-
l ��� )0 1 4-CL' 1 tt�, 4/ 1 k'
Address of property �
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 of notification.
Please initial below if you have no objections.
jI 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, Wilmington, N. C. 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 pi- , sock, mooring pilings, breakwater • :- house,lift or
sandbags must be set back - •s'nimum of 15' from . ea of riparian access
unless waived by me.(If you wish s • .ive the - sack, you must initial the
appropriate blank below.)
I DO wish to w.'. - the 15' setback require t.
I Be 1 OT wish to waive the 15' setback requirement. `�wa
zet kjit 3- d3--9'g Signature & Date
4 e2 <10 � � Print Name
gm - c S6 - y/,E ' Telephone Number w/ Area Code
PLEASE SIGN AND RETURN TO; F&S Marine Contractors,Inc.
P.O. Box 868
Wrightsville Beach, N.C. 28480
Phone/Fax [phone]