Sloan

CERTIFICATION OF EXEMPTION
FROM REQUIRING A CAMA PERMIT 0.
as authorized by the State of North Carolina, e
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. 1'
Applicant Name \ Juhn . ita ft �, Phone Number 1-r3- `t
Address P© 10),. 14(r a
City 3 4,4 rr r , - State t Zip 6y4c"
Project Location (County, State Road, Water Body, etc.) tC)r S I D vJ C t.)kA. n , 'LI 7 fat -t'Yee±,
'Su rI r ', 41 , tJ j Mir- Mr ,) Crt-r.fN 1
Type and Dimensions of Project -12uoF QUcf c k\5i i nc.` duc k- 1141 X i Gt
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- _ �?`.,`.?- ', ( 0C-6,
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 ` ' __.Adevelopment. ( 'C.AiciaI's signature
av ICI `tO
The applicant certifies by signing this exemption that (1)the ap- Issuing date i
plicant has read and will abide by the conditions of this exemp ` u ' 1 9 Gt ci
tion,and(2)a written statement has been obtained from adjacent

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NO_TIFICATIONIW1Iyy,R FORM
Name Of Individual Applying For Permit: . J .i, l '
Address Of Property: �—' D64 c
5 /)_, 64i � —o � ', ir/&c)
(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 the 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. - i
13
If you have objections to what is being proposed, please write like Division of Coastal
Management, 127 North Cardinal Drive, Wilmin, on 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.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
X)-026-51g AlrA
Sig�e � Date
(46-7Print Name
576- - 2 NCDENR
Telephone Number With Area Code NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES

DIVLSION OF COASTAL MAN AGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFLCOTION/W ATVER FORM
Name Of Individual Applying For Permi
t: ti Ol�� /4-/lJ
Address Of Property:
C'aLI-7
� City & County)
A/e
(Lot or Street #, Stre t or Road,
I hereby certify that I own property adjacent to the above-referenced property. The individual
applying for this permit has described toitie 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. % 3 oc_1 _/' kr e R
If you have objections to what is being proposed. please write the Division of Coastal2�405 or call 91 Q 'i95-
Management, 127 North Cardinal Drive, Wilmington, North Carolina,
3900 within 10 days of receipt of this notice: No responses considered the same as no objection
if von have been notified by Certified Mail
WADZ R-SFC_TION
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.)
V I do wish to waive the 15' setback requirement.
I do_ricz wish to waive the 15' setback requirement.
itf61,-
Ad&-lociriA
Si e�
Print ame NCDENR
CA NoFrrr+ cp,gounn DEPARTMENT of
Telenhone Number With Area Code ENviRONM ANDOLI A RESOURCES