Ledbetter (4)

CERTIFICATION OF EXEMPTION
R 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 f \iks e I i e- P he +eR Phone Number �`11C, 37 .1- 6a
Address 'ZcN tI TA,Ic 1 U, &...d /Z; J
City 4..1 State Ai C Zip )(lc-LIci
Project Location( nty, State Road, Water Body, etc.) 1{-rr—. _A��tf�,1 A wiA.
Hj4AGJ°Pr
Type and Dimensions of Project A e`ui Xe j ,< �J /�-e1411�1itie�
C�a I c ,y z /�fi/ �/� �� �- ! P/fj'n,I� /i /11-/(
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:
,r r7A4 / 5Ai" (6 �( / A,'6,t,/ s; C;,.
.f
17
5 441 ;MOO aLrrl.
Any person who proceeds with a development without the con-
sent of a CAMA official under the mistaken assumption that the Appli n's s' re
development is exempted,will be in violation of the CAMA if there
is a subsequent determination that a permit was required for the
development. C Official's signatu
ate
The applicant certifies by signing this exemption that (1)the ap- Issuing ate
plicant has read and will abide by the conditions of this exemp-
tion,and(2)a written statement has been obtained from adjacent gJ99

DIVISION OF COASTAL MANAGEMENT
0 ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION WAIVES FOR M
Name Of Individual Applying For Permit:
lit SSc=/1 4e,i/&\
Address Of Property; ?7
n I ew
Lo , , ,JC Qs yo 0 Newf
(Lot or Stree #, Str et 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
be proposing. A description or drawing, with dimensions,
provided with this letter.
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 North Carolina 28405 or call 910 395-3900 within 10
days of receipt of this notice. No response is considered the same
as no ob 'ection if you have been notified by Cert
ified Mail
WAIVER SECTION
I understand that a pier, dock, mooring
house, lift pilings, breakwater, boat
be setfrom my area of riparianmust access unlessck wai ednby me.imum (If If you
ou of is '
h
to waive the setback, you must initial the appropriate blank
below. )
1./_ I do wish to waive the 15'setback requirement.
I do not wish to waive the 15'setback requirement.
•
g ture16)
i 7 7
ate Y
..A.„r..1fr•
a/ r
gr
Print Na e
Telephone Number With Area Code I-I

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION WAIVER- FORM
Name Of Individual Applying For Permit:
(As'se/ Jc)644.\
Address Of Property: O V( et,i
(Lot or Street , Street or Road, City & County)14-Q~
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 drawin
should be provided with this letter. g, with dimensions,
LO I have no objections to this proposal.
If you have objections to what is being proposed , Please write
Division of Coastal Manaaement 127 Cardinal Drive Extensions
Wilmincton North Carolina 28405 or call 910 395-3900 within 10
days of receipt of this notice. No response is considered the same
as no ob 'ection if you have been notified by Cert
ified Mail
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boat
must
back
from my area of riparian access unless wai ednbyume. (m If If you
of wi15
s '
h
to waive the setback, you must initial the appropriate blank
below. )
_ I do wish to waive the 15'setback requirement.
__1_Y_ I do not wish to waive the 15'setback requirement.
•
S i u re h"—�'—
c y
Date /9Ah S �!� •vacipAPrint ame
F—I
Te ephone N m erAWlth Arz3 Code FR