Dombroski

yr ;a7.-� ..:.mar ru iwv».ua...�nr.--rxa�- wr.Mix—'-7q•`.a•c..-,�-'r '.v wc�v--,n va n e.'rvw SCF-•:-++r
CERTIFICATION OF EXEMPTION
I 0r-
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^b t us ice', , - r Phone Number CO -5-- C ci al
Address (o1 `TZ)rr. e nue ,
City \rr`C.-- State l Zip 9-1D
Project Location (County, State Road, Water Body, etc.) n s I o ur,* � 91 I C ui;c L
< e, P.4 r�l NQ,i , C k.,r1 i cl`
Type and Dimensions of Project IJCAJJ '7'1 P &r e
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: NOT
Cj (.\())wiC IL-
etilSktn
Poi^ pro o5e d
Any person who proceeds with a development without the con- 11 „ 4'2,4
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
is a subsequent determination that a permit was required for the
development. AM icial's signat e G
The applicant certifies by signing this exemption that (1)the ap- n � �) `�f,
plicant has read and will abide by the conditions of this exemp-
tion,and(2)a written statement has been obtained from adjacent \ttmQi 5

•
•
•
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIO VAIVERFORM
•
Name Of Individual Applying For Permit: /, / r )o/6cos,, T
Address Of Property: Zo/ -/y p C'h��/� -c/ $::4 J
I,e c/c 45/2 71.6,77 71: /7/
(Lot or Street #, Street 6r Road, City & County) f
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. idctq!/ a cuoeden, b1okh44_,e Per a rta-d,a dwi, g zacr /0c.c7`i J'a
.otvrM:ewe �y C,4014- o/'i k,a/
I have no objections to this proposal.
If you have objections to what is being proposed pleas- _write the Division of Coastal
Management, 127 North Cardinal Drive, Wilnington, North Carolina ? 4O5_or call 910 395-
3900 within 10_days_n£r ceipt 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 pier, dock, mooring pilings, breakwater, boat house, lift or sandba�tzs must be
set back a minimum distance of 15' from my area of riparian arrrss unless waived by me. (If you
wish to waive the setback, you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
_%-zte,reeZe: V /
Sii:nature D;tu
Print Nam_
NCDENR
Telephone Number With Area Code NDrrn-, CAROuNA DE3-'AR7 MEW DV
ENVIRONMENT AND NQURAL RESOURCES

1 r . iv,.,
I. ti c h x h
`/ �`�
. . 17/717'33 i 1 a.142:%wr
ti ,'17 V?1 Ja191iZ ki*O Jlvr„_ • ''�)♦
eddy 400 •�/_ i?`...
ONb �3 /,M�H is
1,
O %b -Z 9b 4.00r pasvdo,d
x`
7ylMH
ss vl� ys,nu/ h , xvddu—� . 1'. _ 77.9r .y 'r/ 'maul
113Low
sp,41
o � �
_
tow rJ "`.'f �� �y?/1q ra1d � �
`
ioN1V°/ 'LW ehil11
1, - 1 14 l'S 0Q ► K .
,
soNiiid So dofN0 ��015 L'
�Sn�/ oSaeok - - -T - F 51-4 z
I
; }
'7Nrf)a'
o r is.AbN
r-- je -Q-6I Z 110?
v
0
w
I .
1 y j
. _ -lei solo ci c vl i rnuvci--) — 9G
„ o;

•
DIVISION OF COASTAL MANAGEMENT
, f AI>.IACFNT RIPARIAN PROPERTY OWN'ERNOTIF1CATION/«'AIV'FR FORM
Name Of Individual Applying For Permit: ,, l ,()o/i1,4o_5 ; T
Address Of Property: .Lo f 1-t2 2 C4 /4/."c, re
`w S -y l Z,) /0(.4/7i
cLr1/ /(/. �.
(Lot or Street #, Street 6r Road, City & County)
1 hereby certify that I own property adjacent to the above-referenced property. The individual
applying for this permit has described tome as shown on the attached drawing the development
they are proposing. A description or drawing, with dimensions, should be provided with this
letter. ;hs7-4 I/ ct 1 w/ oo 4.ey bu I k. 1 ems p�
r G 71� ®camJ 4 G�` to
d e re re,,'q s-e e,q C T i4 0 44,G'r I"� S.
I have no objections to this proposal.
If you have nhjertinnc to what is being proposed, please write the Division of Coastal
Management_ 1''7 NorthCardinal Drive Wilmington North Carolina_ 78,405 or call 910 395-
3400 within 111) days Jai receipt oflhis 1141irt Na response is considered the same as no objection
if you have been notified by Certified Mail
WAIVER SECTION
1 understand that a pier, dock, mooring pilings, breakwater, boat house, lift or sandbags 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 must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
I tin not wish to waive the 15' setback requirement.
- — .3)5) T A • .A„,
ti _ nature I ):1t
Print Nam:"
3a-7 NCDENR
Telephone Number With Area Code NORTH GANpuw. MENT ot-
ENVIRONMENT AND NRUNAE RESOURCES

761 . Chaduv,CA `.�hofos LA.- -
,
IA
o, _ye.__3Z ____, a:
/A/1 Li t LC> ii LI------ 15.-)
a) LoT Ili
84 A 0 Ch4dtock :)+orr; S,
faro)d 0
Corinne- { ! 36 lour
•• 1
T. Aac%Cred ..
,? stool owToP i a
3Z1 r i 80o 51. FT ose,P
• L.cite'f" o+ P
iieerois al/ weTlt►.iL
— Lam- 12.(0 ). ; I Ist e a
ri
4W til-
mean N,yA 36.�6 4 4,, f ,� _ —APPnx . 4' marsh 5ra sr
S Ze /,;?,. .iA7,:',• an G:rax& lad
erofIDCRd avot 9G = 296 .O
Rev W ScR(�
„�4�� �.A�0 APPR h
4t� -"MT VFO I Zy 7Dr!�A)L
-a' ire , q�� REF .2X4 iouttn.d,hre� o )
yxy