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CERTIFICATION OF EXEMPTION
'FROM REQUIRING A CAMA PERMIT
as authorized by the State of North Carolina,
0 Department of Environment, Health, and Natural Resources and the Coastal Resources Commission
in an area of environmental�p 'concern pursuant to 15 NCAC Subchapter 7K .0203.
Applicant Name NI\n {`.ktSS _ Phone Number Q i 0 28S -Z173Address j UCk C F, sk 5+ ks L+kr\�
City UU A LIA r State /y Q _' Zip)e d6(p
Project Location(County, State Road,Water Body, etc.) ~- � c or
tU /NI 1ZOr\a t 4 nr-,vsk- vfcJ C 1 r ttP,\ (V o f o I1,J
Type and Dimensions of Project Nrv.i b u 1 K\\ d - 501 LUT
The proposed project to be located and constructed as described This c'--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 .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: N3c T ru )
.pt o PO seci hit 1 Ili•- c(
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Any person who proceeds with a development without the con- AL{,(__ , .i/
sent of a CAMA official under the mistaken assumption that the Applica is signature
development is exempted,will be in violation of the CAMA if there
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is a subsequent determination that a permit was required for the � - 'Cr\
development. CAMA O'ticial' signature
thatthem l � '999
The applicant certifies by signing this exemption (1) p Issuing date
plicant has read and will abide by the conditions of this exemp-
tion.and(2)a written statement has been obtained from adiacent Ki wem).--tAJ I I . 1999 1 G!9

NCDEJ-PR WIRO Fax:[phone] Mar 8 '99 10:12 P.05
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DIVISIOi OF COASTAL MANAGEMENT
,B,pJACE1T RIPARpAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name Of Individual Applyingyi� For Permit: L-1/1/7 9)/v 9l/j,/A49 /���
Address Of Property: (� 7 /4461./y /2/ i/
/✓r.7/45/et/
(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 objections to this proposal.
If you have Qbiections to what is being DYoopsed pie se wt to the
division of Coasts N1anaQemenr Z27 Carrii,nal nr'_e Fsxtpn_sznn.
wiZ.z. on. North Carolir_a. 28405 or a1] 910 395 �9nn within 10
days of r pt of this nor�ce No res nse is � „ idered the -
as no objection if you h-vE b en notified by Certiried.tajl
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boat
house, lift aummillOMB must be set back a minimum distance of 15'
from my area of riparian access unless waived by me. (If you wish
to waive the Setback, you 'meat initial the appropriate blank
below.)
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I do wish to waive the 15'setback requirement.
I do pot wish to waive the 15'setback requirement.
GQsi n XGature Date
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elepho a Number it Area Code L`1\U� p��— �yD�