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Home My WebLink AboutGriffin CERTIFICATION OF EXEMPTION FROM REQUIRING A CAMA PERMIT as authorized by the State of North Carolina, i✓� 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 1 ,On t..kS V r I - l i` Phone NumbeCP�)B 117- 693a Address 1 o� o die Vvi 1 a ieuK 6 City !. St tg Zip 5 Proje t Location(County, State Road, Water Body, etc. a l /u Z 0«�A _l S 1,f u k-L1 Is "1 8 r n ,L4J /L k (o..-i 4-y p A M c. ,a- M a (4{ Cat .A c{ Type and Dimensions oi Proj ct1041 .'Ft-'(.-+ DVL k r� ,p, 4. T- A( - ()A' >(to') nn+" o OK( ea e_>t-ah IJptcr 1ic.4 /c ' -1- ti . AI( c.on� fr.�._-4- .. 5I.4/ h ( 4-i- /e61•)J f5F4- /AS/ C e C, ri,uriu.." (3/-4- 1ii .... f . C`-)ils I'J“-- 7J.4 SX- ii .3 * [M p e coo n (1 ./t 4 1--(', ...-, The proposed project to be loc'ed 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: Ah 4- 7, S(N- ) <---2 Aq,n—mo. Q\ ( CLAl)LA1 2--------- -1 /O" 3 ' )C /W II ill X'-11 -- Ext.;4-•,,i 13,.,/ / 4f,4d .' \ < 6sFr } Any person who proceeds with a development without the con- (-' �,% sent of a CAMA official under the mistaken assumption that the Ap ' a ignature t development is exempted,will be in violation of the CAMA if there \ is a subsequent determination that a permit was required for the `tt Cl AA.,,,......„, development. CAMA Offiofal's si ature 6 - The applicant certifies by signing this exemption that (1)the ap- Issuing date plicant has read and will abide by the conditions of this exemp- tion,and(2)a written statement has been obtained from adjacent v� 1 SENDER: I also wish to receive the O ■Complete items.1,_nd/or 2 for additional services. Cl) •Complete itertis 3,4a,rnd O. 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. j ■Attach this form to the front of the mailpiece,or on the back if space does not 1. ❑ Addressee's Address F2 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 o 3.Article Addressed to: 4a.Article Number E. a �IkzCtUe�h V rr Z `1�---7 DO-1 gO 0)- E 4b.Service Type 0 o n ? 1, d� (t;-7. ❑ Registered Certified n ❑ Express Mail 0 Insured Li ChG ,A �� 2��u to Receipt for Merchandise 0 COD D 7. Date of Delivery( z J '6, 9 Cj D 5. Received By: (Print Name) 8.Addressee's Address(Only if requested u and fee is paid) ✓ i 6.Sign : (Addressee or�Agent) (\�f jo Ltiy/t.C�-L. 0) PS Form 3811: ecember 1994 (/U/ Domestic Return Receipt ' . ^ ^ ' . DIVISION OF COASTAL MANAGEMENT ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM Name of Individual Applying For Permit: Address of Property: ____________________ (Lot or Street #, Street or .)ad, 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 objectives to this proposal . If you have objections to what is being proposed, please write the Division of Coastal Management, 127 Cardinal Drive Extension, Wilmington, NC 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 sat 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. ___________________________ _______________________ __________________ _________________ _________________________________________ -~-'-� -'''-------l7 ----- 51 ure Date ,�'' �� °� 7�� J -- [» �? �. / �L,, ~� ^- / / , "= /K� �� _~ --��`��`�`--�`��---�� `----��` �� ````�` ��... Print Name �~/� � =+ �- � � T ~ �� ---_ -------------------- Telephone Number with Area Code 7 SENDER:■Complete items 1 and/or 2 for additional services. I also wish to receive the n .I 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. I > •Attach this form to the front of the mailpiece,or on the back if space does not 1. ❑ Addressee's Address • u permit. I u ■Write'Return Receipt Requested'on the mailpiece below the article number. 2. ❑ Restricted Delivery , • •The Return Receipt will show to whom the article was delivered and the date i. delivered. Consult postmaster for fee. i 3 3.Article Addressed to: 4a.Article Number I - -_��1 47.17 01 803 1.. 4b.Service Type i o S1 e QZ G 0 Registered �ertified t 0 Express Mail 0 Insured ! j OCC1 r\ -r-s1e ' .ea c11, K 0 Return Receipt for Merchandise 0 COD 7.Date of Delivery �� i 5 5. Received By: (Print Name) ( 8.Addressee's Address(Only if requested t and fee is paid) h 6.Si natur2:,...(1ddr a Agent) L � �, ▪ �nT-C1.snI r..1 ___—L__.nnA V _ flnmoctir Rot'irn Roncint . . . ° . , DIVISION OF COASTAL MANAGEMENT ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM Name of Individual Applying For Permit: Address of of Property: 'A__.A. __________________ �_��__�� _ (Lot or Street #, Street or Roao, 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 objectives to this proposal . If you have objections to what is being proposed, please write the Division of Coastal Management, 127 Cardinal Drive Extension, Wilmington, NO 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 sat 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. ) ___1m�� I do wish to waive the 15' setback requirement. I do not wish to waive the 15' setback requirement. _______ _______________ _______________ _______________________ _____ - -------------- ----- --------------- �Siigan��-e- �r--��-------------------e- __ .�. '�'�� .........................................._____ Print Name � _�_�_ _______________ Telephone Number with Area Code