Butcher

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��jj concern pursuant to 15 NCAC Subchapter 7K .0203.
Applicant Name l 'S1 n `U UIC/�e" Phone Number 1/0 328 asc'7
Address / Co► C21 d v i 1 1 /9 y n�
City set' ianc1, State n/C/ Zip 0284 r-
Project cocation (County, State Road,Water Bo y, etc.) n S 1o(A) COt-i n /6D l old r Rl i
r+f, cps► it Ui �I► c_. of -fury Sou•,d) -5-t4nip Sowl
Type and Dimensions of Project /11PIA) pig' �G {�ir9i ►Crr'1 1[o' X l(o'
— No moor► p-k ►enS — I
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 �. mn Sourri ' Df (SCALE: A)0T l 1) )
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or
Less
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Any person who proceeds with a development without the con- AJa/til,C
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 ACA ' '
development. CAM. sign
sig
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, `r_ , �� i � L
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and(2)a written statement has been obtained from adjacent �C�- `�

ADJACENT RIPARIAN PROPERTY CMN"ER STAT N'r
(FOR A PIER)
•
I hereby certify that I own property adjacent to
KR/c-7w:ii.7 a ,4,,<J a___XJ-7-C i-/f� ` s property located at
(Nara of Properly Owner)
.4o / 3S� sr��- 2 / 6 / eis J/Adfici ,? ,kip
(Lot, Llock, Road, etc. )
S.
on iAr (2 - Ct, S%A (.- , in No2')-) '-ruPSja,c___ ?i f c0 , N. C.
' (Waterbody) (Town and/or county)
He has described to me, as shown below, the development he is
' ,. proposing at that location, and, I have no objections to his
proposal. I understand that a pier must be set back a minimum
distance of fifteen feet ( 15 ' ) from my area of riparian access
unless waived by me.
, .,
I do not wish to waive that setback requirement.
do wish to ��aive that setback requirement .
itr_iiii,dietta--...e_20;:e
:/2...4..cie
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPY=T:
(To be filled in by individual proposing develonment)
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6 ' X 1G 1 «LIl v.3 ,'>-f Got (AD ()M w A
Signatur
,<', nJ 4 0(-/ S o
Print or Type Name
q( 9 - SSA - /Se?
Telephone Number

•
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER)
I hereby certify that I own property adjacent to
�l��Svvn9 or ,��N?�} ✓i-c-�1C It y_ ` s property located at
(Nain ± of Property O rner)
(Lot, Dloc1:, Road, etc. )
S 0 rtiP Sove.
o;1 MITER- co f-�S r mac_ , in 1I <rd P5014- 3Eac-)4 , N.C.
(Waterbody) (Town and/or County)
He has described to me, as shown below, the development he is
proposing at- that location, and, I have no objections to his
proposal. I understand that a pier must be set back a minimum
distance of, fifteen feet ( 15 ' ) from my area of riparian access
unless waived by me.
I do not wish to waive that setback requirement.
I do wish to waive that setback ):equirement .
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVi LOPNiENT:
(To be filled in by individual 'proposing development)
(61
e '1Z / t f 5�°•
P,
/G j116 ' .b CK '714 C waA } qy
Signature
S,1,, 7v'/
CEWE Print or Type Name
Telephone Number
JUL C ' 1S98
DIVISION OF
COASTAL MANAGEMENT

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JOLLY HILL, SOUTH CAROLINA 29059 South Atlantic Region 800-923-636
AC 803-496-5027 919-878-729
• S.C. Toll Free: 1-800-922-7001 Santee Region 800-845-112
Dut of State Toll Free: 1-800-845-7051 803-736-070,
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J JUL 0 7 1998 Li / ,4 3 ,,Da;O R
• DIVISION OF
COASTAL MANAGEMENT
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