Bryan (3)

,I' CERTIFICATION OF EXEMPTION
-Y-
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
'n an area of environmental concern pursuant to 15 NCAC Subchapter 71 .020
Applicant Name I C 1 4-r b r cq i1 Phone Number
Address /11 O 0,t4-1, r R/✓4 V/4rt'
City <<q o (7 !• {u L c� State Zip a' `'/b2
Project Location(County, State Road,Water ody,�,�etc.) 4V3 , / a . 12 ? o D ,' S a "1
A • MYOe , Akl / A 0n'i(n ltiLA , I-- d,1Su.IL �. t t I1
Type d Dimefts'�nsof P oje (l�r 4-, s r 04-4 / �j J Z,.,1 ie.( Ct Fttk /- ,. d "'4,,,
t) -e> 11S t/1 k AP,K a s ., �ti 5. / cep -d- / 0 L, 'P-� Wq -P�-vt, ca.(e � y4' a5pA,_, 1-4- 0 .1 /1 r- -1- A s/(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: No{-74 S-„/e)
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AnyL. AsfrA077/
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person whoproceeds with a development without the con- I �JG�-lam{ �'
P
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 "v`J
is a subsequent determination that a permit was required for the �� Cal
development. CAMA �i�ll's signature
The applicant certifies by signing this exemption that (1)the ap- 1 r
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 5

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ucfu -aa rUV./l ii:uJ rAa ai 04‘ Jcoc mLliW1CLfli
N
ptV sTON OF COASTALM�NAGEMENT w
ADJACENT RIPARYAN PROPERTY OWNER OTII'ICATION WAIVEa FORM
Name Of Individual Applying For Permit: S`
r
Address Of Property: --
al kr DAL
&(Lot or Street 0, Stre t or Road, �-
City & county) .. -
I hereby certify that I own Y
1 here referenced propezt property adjacent to the above-
describedy• The individual applying for this permit
to re as shown on the attached drawingP nit has
they are proposing. A description or drawing, the dimeloions
should be provided with this letter. with dimEnsions,_
L/ E �-cc)
I have no objections to this � '
proposal.
If you have oAlECt10nS to what is be:nv Division f Coastal Menaveraent. 127 vr000sed , please write
wf minoton , Cardi al Dr; sione
Northh C iina 28a05 or call 910 30 oe i
ays of receipt of this notice. 5-3.00 within 1e _ ;
as n0 ObiE� No reSDOns2 s Co id red the sang
_tion if you eve been oti led by Certified Mai
�� I
WAIvER SECTION
rI understand that a pier,
ound, iif , dock, mooring pilings, breakwater, boat-v must be set back a minimum distance 15'
from my area of riparian access unless of
to waive the setback nle_s waived by me. (If you wish
below. ) you must initial' the appropriate blank
')(\---- !� I do wish to waive the 15'satback requirement.
----- I do not wish to waive the 15'setback requirement.
,,,:,.
0 /Qi�c_ 2
Sign ture /g/�1 . .
•
• J� E ti(, Date
A • .A
Print Nerve 1r
. 110 - hg5 - S
SZy
Telephone Number with Area Code CD H x'

s .
DIV
SION OF
ADJACENT RIPARIAN IP OPERTY OWNF COASTAL MANAGEMENT NOTIr ICATION WAIVES. FORM_
Name Of Individual Applying `c `-�/
For Permit : �- ZT a ete.vpd.)
Address Of Property: /2c -ai h /,v L2
(et ( E14C k . . 132icySleil e
(Lot or Street #, Street or
Road, City & County)
I hereby certify that I own ,-
referenced property. Property adjacent to the above-
descr The individual applying for this
permit has
ibed to me as shown on the attached drawing the development
they are proposing. A d �.scri
should be provided with this letter or drawing, with dimensions
43.4&-I :_
• have no objections to this proposal.
If V011 have ObleCti +�_ons to what is being proposed , lease write
Division of Co- Di _t_ the
Coastal Management .
�vilmington . North Carolina , 127 Cardinal Drive Extension
days of receipt of this , 28405 or call 910 395-3900 within 10
as no f receipt
tic- No response is considered the same
_tion if You have been notified
- by Certified Mail
WA'vER SECTION
I understand that a pier, dock, mooring Pilings, breakwater,
must beback a minimumboat
from my area of riparianset distance of 15 '
access unless waived
to waive the setback, you mustinitialby me. (If you wish
below. ) the appropriate blank
I do wish to waive the
15 'setback requirement.
I do not wish to waive the 15 'setback requirement.
elSig t re T
Da eA •
•
Pr Nam �,r
40 j __
Te ephone Number With Ar a �}—�N
e_ Code