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Home My WebLink AboutGrubb - es ' CERTIFICATION OF EXEMPTION v FROM REQUIRING A CAMA PERMIT as authorized by the State of North Carolina, ry 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 -fNS4 G � -R6 Phone Number !f/o) k 9. -/erlY Address 3.1 I, /11 M Net C/iSel< PI4(F City 5S,/;v,it State it/C Zip . d Q.)1 Project Location(County, State Road, Water Body, etc.) 3.1 SZ /?1 al/ 'I <A' ett 04y 41,✓Pr 64 Av 51.4 W W1'5)0 4, A rl/4e Rk.-1 (i C"(Woo/ $ Frl//t/ /e l✓Pr- / Q?AI A SwiC,C jN,(/r Ty/ppe and Dimensions of Project ('fi ti}1"iv 15'B1`-- et 1 / i v41 Aer /4,S !1- r x 9 ' ,"''A /2 % '' T N/_-Ao, 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. 'y 'I + I =5., G f ?K ,0., c 3 :)fh4 ri 4ePiy SKETCH (SCALE: ) £6L<,^,o cCS /I`f R;yrr I � N i�` ay' 1. siI 1 l i if / As / 4 1 / , i /S,MrA., n.r1M 41. � Iv of;pAri�- c oa'eol M. ` '. Any person who proceeds ith a development without the con- -., .> - `--� --`G� 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. C fficial's signatu The applicant certifies by signing this exemption that (1)the ap- ladatte 9 r Issui g plicant has read and will abide by the conditions of this exemp- tion,and(2)a written statement has been obtained from adjacent 5 hi 9i �• SENDER: •'DO_ •Complete items 1 and/or 2 for additional services. I also wish to receive the (n •Complete items 3,4a,and 4b. following services(for an N •Print your name and address on the reverse of this form so that we can return this extra fee): card to you. > •Attach this form to the front of the mailpiece,or on the back if space does not 1. ❑ Addressee's Addre; d permit. y ■Write'Return Receipt Requested'on the mailpiece below the article number. 2. ❑ Restricted Delivery .t. •The Return Receipt will show to whom the article was delivered and the date c delivered. Consult postmaster for fee. 0 v 3.Article Addressed to: 47rtiele Nu ber / M 44 /1143 7v5 ; .RPDAI-F r� 0l L/ I a Y E 4b.Service ype o o Lii Z k'/v/6 y*s jR'Pb F 0 Registered ertifi cn cn n n� 0 Express Mail 0 Insure S w /',! 6 /1)Lt, C- L cc 0 Return Receipt for Merchandise ❑ COD 0 R 0 5) V 6p' / 7. Date f Delivery � )6Im5. Received By: (Print Name) S.Addr ssee's'dess(Only if requester w and fee is paid) cc g 6.Signature Addresseg.prAge PS Form 3811, December 1994 Domestic Return Rece Z 251, 609 842 US Postal Service Receipt for Certified Mail Z 251 609 541, US Postal Service Receipt for Certified Mail No Insurance Coverage Provided. Do not use for International Mail(See reverse) nito Sireef&Number 1411 iYN/6 7,1715 .)42j ,— Post Office.State,&ZIP Code S124'v f/IlL / /=L 3 YZ 1 Postage $ 5.N Certified Fee Special Delivery Fee Restricted Delivery FeeLto / l Return Receipt Showing to 1, T Whom&Date Delivered Return Receipt Showing to Whom, < Date,&Addressee's Address l 0 TOTAL Postage&Fees $ r / ch Postmark or Date %%%111 111 E 1 v7 a c'• SENDER: V ■Complete items 1 and/or 2 for additional services. I also wish to receive the rn ■Complete items 3,4a,and 4b. following services(for an N •Print your name and address on the reverse of this form so that we can return this extra fee): d card to you. ■Attach this form to the front of the mailpiece,or on the back if space does not 1. ❑ Addressee's Address E permit. y ■Write'Return Receipt Requested'on the mailpiece below the article number. 2. ❑ Restricted Delivery .c •The Return Receipt will show to whom the article was delivered and the date c delivered. Consult postmaster for fee. 0 a•°i 3.Article Addressed to: 4a.Articl Nufnber E / 4b.Service Type o 0 //I'L L x D49/v/ Cl Registered I to cn ❑ Express o_R`r� 0 Insured � I yn � � �¢ 0 Return R r Merchandise 0 COD a 7. Date of Delivery z m5. Received By: (Print Name) 8.Addres' e' s(O/I/yi requested w and fee i • ¢ Sp 0 6.Signaturq; (Addre ee or Agent) N c-iyte :Psi [J 1n ►Jybt 0 "CS 4c' ") 'Id Ufa-640 _pp n W 9 ;-ce ifit ,71 na, opu i-1 o; 05 +°'1 ?Ai/7 avit." �31� M .-:---..\. --N__, / Nr 1I1 �a3 I I�� lei off. A.9i • i�6 • tlia 11 ', Jt 11 11 ..° >INV9 ,�5 ,DNt1 1(I 1 iil' /rA k „It 1 a �I� /l) ��4 �, I I� 11 I .a , 6 f , �� .S�/ f I\ i 1 ` 'II ` 11 `� !rr '; /it ''1 , ► I. Nr"� ,� _1r � ,i 1�1 it "l 1 -I t i .l II -. I{\ ' Sl'f �6'11' - 1 I - Dif4 w / / Ili - 1n I1' it_ • 'fi ' O t. )4,,, '3 t tk - -- 11 -1 )1 - I ..,..,�- a P r ° 7 - - , p T f - izxri 7 ,a—f-- l -.-: ��,,i aPa goy;® '7 0 ° `'A) 7- 5-3 ' y v s" 5— ° DIVISION OF COASTAL MANAGEMENT ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM Name Of Individual Applying For Permit: 1.- :ndo... t.. Cxrcc,(rl, Address Of Property : 5 c M.L4., l-e Cr -c. K r H. ',.E • /2.Lil N j w x-ic. �,c: -I.N Ty . 23 Q c P' f 6.t'J i.)l. .v fi4 it,.)" (Lot or Street = , Street or Road , City & Count'; 5c)--.u i`o.. AJ ' 2.e3-I.Z 2. 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 lei:ter . 4,____ 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 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 tack 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 . z- i4-9. W Sig tore Date A . .A� �m E �E 1�/9G ._ ,V�,,_ 1 Print .;ame .��► 35-2 G. 4 6 - 73 3 9 D om }--3 NJ R Telepncne Number With Area Code DIVISION OF COASTAL MANAGEMENT ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM Name Of Individual Applying For Permit: 1-1✓ Ja, (. - (,X,^(,t„ bb Address Of Property: ;A56 M wII cf l',r c e k Flc-c e S_e. i5 L-/v 1 A- i' C, .29 y.22 (Lot or Street #, Street or Road, City & County) c ,c,46wlc(c u-'t y 12iuer g,uA) 194.rnilri47!dAJ 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 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 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. ) r I do wish to waive the 15' setback requirement. I do not wish to waive the 15' setback requirement. ,1n ctiA 1,11AWd k -1- 63 Signature c Date 1 • I--R rt NI A N .>AlPi R c) Ki Fk?. 1 DR- Print Name r+ q1D_ Ii- 1- 6 - 4- CEF-1NFR. Telephone Number With Area Code