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• 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 cAr loL1'n c I`n S t la ri N! Phone Number I C 7c6 30hZ
Address (o 10 j t c tram Y Ac L c v Dv
City t kv.( nr-a-{- -', State N Zip Zity_p
Projec Locatio (County, Ste Road, ater Body, etc.) (� W g�/N i c {� I u d . ui r i'L Q'9
Type and Dimensions of Project -Pr 1 v 1-7u_1 La 4 .0 — i\/ !H A
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:
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AMA
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Any person who proceeds with a development without the con- T
sent of a CAMA official under the mistaken assumption that the Applica ' Nture >
development is exempted,will be in violation of the CAMA if there
71 is a subsequent determination that a permit was required for the
development. CAMA Off i ia1`s sig ature
_CL7
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 . ` 12 `9 9
JAN-OT-99 THU 12 ;16 PM P3.9 MARINE CONTRACTORS 9102563062 P.01
A
r
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION &WAIVER FORM
Name of individual applying for permit c). /nc ,1,1)rt/ ii V q /ii i
Address of property J f,ht lotA. V vb, /4 t po i> lsos At.
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 .81,t1r..a n'CAn+h
S� I have no objections to this proposal. '¢t r tad et
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 dock, mooring pilings, breakwater ouse,lift or
sandbags must be set bac inimum of 15' from a of riparian access
unless waived by me.(If you wish ive the ack, you must initial the
appropriate blank below.)
I DO wish tow • e 15' setback requ r t.
T wish to waive the 15' setback requirement.
9 9 Signature & Data
S2o7 f/lig 6 U✓-J Print Name
�0 5- —,5G /2... Telephone Number w/Area Code
PLEASE SIGN AND RETURN TO; F&S Marine Contractors.Inc.
P.O. Box 8613
Wrightsville Bath, WC, 28480
Phone,Fax 258-30+82
4
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION & WAIVER FORM
Name of individual applying for permit S1)5411) /ikhiI/J,q.✓/j/18/ -k02.
Address of property /O /deride- V✓o' tiztyllr ? ) /VL
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. 1r Saikikeem frrcmt,d
I have no objections to this proposal. /41-a
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 t house,lift or
sandbags must be set back a minimum of 15' from rea of riparian access
unless waived by me.(If you wish t ive the ack, you must initial the
appropriate blank below.)
I DO wish to w the 15' setback requirement.
OT wish to waive the 15' setback requirement.
74JJ Signature & Date
�► '`114+i( 'e 1 Print Name
vl'l O 2sqp- "713 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 256-3062
f&S Marine Contractors,Inc.
. 74.,
1?A bS , � ICldz' Wrightsville O.Box�NC 28480
(910)256-3062
CM,A
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