Bennit

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. n,-f-
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Applicant Name S PA 73 P.v4" I C/o (y�t'�G /dery Phone Number k t/J,S)
Address f', O. (30, ,'8 6--
City %/PRP State PVC Zip ak 33r
Project Location(County, State Road, Water Body, etc.) /7 7Y �A-7` S PR 4;/PP (.4A4 L1/ li'Ve"
S�A- !. P 4=7' J , sK/ofly / ,vc A p J 4 r-p-4- ,q.rwn,
Type and Dimensions of Project P,Atkie,n + p t- Ifi'�t,G d 1/X/f 5V' N:�
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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.
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Any person who proceeds with a development without the con- ��j
/deAl.
sent of a CAMA official under the mistaken assumption that the App( nt's sign u
development is exempted,will be in violation of the CAMA if there
is a subsequent determination that a permit was required for the g^
development. CAM Offici I's signatur
The applicant certifies by signing this exemption that (1)the ap- ��3/y(1'
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 /c) 3//!J

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name Of Individual Applying For Permit: Sc ra, iie0),`71
Address .Of Property: /2 7 V /� 5-ea At-
(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 cn the attached drawing the development
they are proposing. A description or drawingi • with dimensions,
should be provided with this letter.
I have no objections to this proposal.
If You have objections to what is beinc or000sed , please write the
Division of Coastal Manacenent . 127 Cardinal Drive Extension,
Wilmincton, North Carolina . 23405 or call 910 395-3900 within 10
days of recejot 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 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 do not wish to waive the 15 'setback requirement.
/.//"2-./9 2
Signac r Date A .
•
Print Name ^-��•
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Telephone Number With Area Code

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DIVISION OF COASTAL MANAGEMENT •
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONfWAIVER FORM
Name Of Individual Applying For Permit: ,$ /r4 Se J1y7e ./
Address .Of Property: �' �1�� l_/;
Ci.a
(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 objections to what is beinc proposed , please write the
Division of Coastal Manacement . 127 Cardinal Drive Extension,
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 obi ection if you have been notified by Certified Mail
WAIVER SECTION
I 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 recuirement.
I do not wish to waive the 15 'setback requirement.
r �
)ignature Date • •
4611
Print Name '
Telephone Number With Area Code

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