Knott

CERTIFICATION OF EXEMPTION
FROM REQUIRING A CAMA PERMIT
as authorized by the State of North Carolina,
0 Department of Environment, Health, and Natural Resources and the Costal Resources Commission
in an area of environmental concern pursuant to 15 NCAC Subchapter 7K.Or203:
Applicant Name Ff C.,n K o ! Phone Number
Address 570 L) N. �,>ti ha v e.r
City : - L. State AJC_. Zip -).Fs<16ci
Project Location (County, State Road, Water Body, etc.) '79 I.Vikk-,,, t -,., D c Pc �S4.7 ,RTN
pi1,5rtJA ) w/L l\-' (`s o ... Main , .1,‘ .14( cc1i1 -
Type and Dimensions of Project / L `� /‘ ' Tc.,., o �—
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e -7 -I- (l4 ) 15 F� , s, Jr �Vf4 rtlo,r,w.� Crt,c0✓
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- l/` j+ _,,e,,e4
sent of a CAMA official under the mistaken assumption that the f nt more
development is exempted,will be in violation of the CAMA if there
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is a subsequent determination that a permit was required for theC,. U
development. CAM ffictal's signature o�
The applicant certifies by signing this exemption that (1)the ap- r [ 0
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 ' I ' -(
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SENDER:o .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
'.1: ■Print your name and address on the reverse of this form so that we can return this extra fee):
card to you. r
j •Attach this form to the front of the mailpiece,or on the back if space does not 1. ❑ Addressee's Address •i-
2 permit.
y ■Write'Return Receipt Requested'on the mailpiece below the article number. 2. ❑ Restricted Delivery c
c •The Return Receipt will show to whom the article was delivered and the date
c delivered. Consult postmaster for fee. 1
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a t 7. Date of Delivery
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z 5.,Received By: (Print Name) 8.Addressee's Address(Only if requested 1
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g 6.Signature: (Addressee or Agent)
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PC Pnrm 21111 ofaramhor 100A Domestic Return Receiot

cs' SENDER:
70 •Complete items 1 and/or 2 for additional services. I also wish to receive the
a •Complete items 3,4a,and 4b. following services(for an
y •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 Address •
d permit.
a) •Write'Return Receipt Requested'on the mailpiece below the article number. 2. ❑ Restricted Delivery f
Is •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: 4a.Article Number 0 Q Q
B 4b.Service Type
o
u 0 Registered Certified r
u�i f 0 Express Mail 0 Insured !
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0 �gLlV'N r\ �/ \ �] Return Receipt for Merchandise 0 COD
0 7. Date of Delivery
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5. Received By: (Print Name) 8.Addressee's Address(Only it requested
and fee is paid)
6.Signature:,fAddressee or Agent)
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PS Form 3811. December 1994 Domestic Return Receipt

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^ ... ° .
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 RoaA, City & County)
I hereby cer ti fy 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
pro v id e d th this letter .
c'-____ n b opo l .
If you have objections to what is being proposed, please write the
Division of Coastal Management , 127 Cardinal Drive Extension,
Wilmington NC 84
, 20 5 or l cal 91 0-395-3900 1O within 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. )
do wish to waive the 15` setback requirement.
I do n ot wish to waive the 15' setback requirement.
___..._.........___............................................................
_
_..............................................________________________
-- ....................... - ........... ....'� 7�~�-��
Si a��re� Date
� ....._...................________
P Name

. .
^.. . °^
'
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
`
Name of Individual Applying For
Address of Property: _ __ ��_� _���. _____________
(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
pro id 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 91O-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.
.............. ..............._.........._...............................................................__....._..............___
---------7��==----------- � / l�----------
Si at / Date
_.........
_____
Print Name
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Telephon r with Area Code
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