Lea

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.
Applicant Name " A r Lf24t Phone Number al" o Ir3a ki 6
Address o &elf OAK- O r i _i
City i, - i State r Zip �i`rZ�L- '
Project Location (county, State Road, ater Body, tc.) A , / 6- Oa-,
'brit ( bQQ-tr( etd -Ik c),S ri.•-� t
4 + TIA)
Type and Dimensions of Project
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: ,N6-r To )
\iu 6,*-- -;_-\-kesNr\r, kAl kv \.1/ ,i,
_
Any person who proceeds with a development without the con - --xf
sent of a CAMA official under the mistaken assumption that the Appli nt's signet re
development is exempted,will be in violation of the CAMA if there A ---Nr( 424....C.Q__,
is a subsequent determination that a permit was required for the
development. eA A icia s signature
7 fu i Ia9B
The applicant certifies by signing this exemption that (1)the ap-
Issuing date C9 1 kG b
plicant has read and will abide by the conditions of this exemp- � -1
..__ .....a in\,.,...Ma......G.,+,...,,...1 h.,,L,r,r,.,r.ktainnrl from arfiarnnt D/�lL

— sc-dL:g v_vs --?/av
d 4 Q dQL -
-TDv
b rQ 29 ,tee Ss To 3_0
,, o ) ) ,, -*/ ,�2(- ro ? Z (4_ dQD
Pi-?1 /
l D (sQ) � � ? � � )
9(),R_Lq /-6/Q ,Lfrorn
v, 70 C)-17/ 21q 'a- anb/
41:9c_j021 4-&-9 scfci
. ,o. r47, oq o v�i-17 i(2(V,72 ° 2Z(V frig? 2 1 i N0
X6i
ViN
< ()1 d .6/ kl\'4
? 7k;)Crie
Sp L 14 Q aaQ-
(y �j

• •
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVE3. FORM
Name Of Individual Applying For Permit: ;faLitLC
Address Of Property : 4-�. Q12- -I4r o * b ?e yr
111-1Ps s4 ill C� a�3 q tic N i� 2 C yr
(Lot oW Street #, Street or Road, City & ourty)
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 cr drawing, with dimensions,
should be provided with this letter.
I have no objections to this proposal.
If You have cbiections tc what is beinc Dr000sed ,• Pleas= write the
Division of - Coastal Manacement . 127 Cardinal Drive Extension,
Wilmincton . North Carolina . 28405 or call 910 .395-3900 within 10
devs cf receipt of this notice . Nc response_ is considered the same •
as no objection if you have been notified by Certified Mail
WAIVER SEDTION
I understand that a pier, dock, mooring pilings, breakwater, boat
house, lift or sandpags must be set hack a minimum distance of 15 '
from my area cf 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.
to 107
§}gniture Date ` • i "
P r/�.n t tear;g� �

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTiFICATIONIwAIVER- FOAM
Name Of Individual Applying For Permit: ;100aLitLc-
Address Of Property: 4-a Qyze4T p f}k 'vt
-AtiPzfb.itht kl, a, Re941.3 t�Nbeia CAI ill
(Lot oW Street #, Street or R 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.
V/ i have no objections to this proposal.
If You have objections to what is beinc Drceosed ,• mle_se write the
Division of Coastal Manacement . _ 127 Cardinal Drive Extension .
Wiimincton . North Carolina . 28405 or cal? 910 '395-3900 within 10
days of receipt of this notice . No resmo*se is considered the same
as no obiection if You have been notified by Certified Mail
WAIVER SECTION
•
I understand that a pier, dock, mooring pilings, breakwater, boat
house, lift or sandpacs must be set rack a minimum distance of 15 '
from my area cf riparian access unless waived by me. (If you wish
to waive the setback, you must initial the appropriate blank,
below. )
I do wish tc waive the 15 'setback requirement.
I do not wish to waive the 15 'setback requirement.
f
V(/t7E- C,417.3 : lz (3/7
`-ure ate ` •7
PrintNt
/ i,� _me
��