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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.
,c Applicant Name ' t M P, Phone Number
Address A I I rtA n
City Du( h++-rl State NCB Zip o? 77Q,
Protect Location (County, State Road, Water ody,etc. Q-1, f 'In
" 1vf✓ : It; �F�,1 `k chi �� f `: Pr- -6 h n.-ic_1
Type and Dimensions of Project u) bOP� \�F±- ( unco Uex-td) find P‘OeNT to
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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1,Any person who proceeds with a development without the con- OW-VI
sent of a CAMA official under the mistaken assumption that the Appli nt's signature
development is exempted,will be in violation of the CAMA if there / 1 Q ��
is a subsequent determination that a permit was required for the
development. CAMA Offici l's signature
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- �a �G�-I^,D
V
in\ ..,.;.. . . .ti��ti�on,Intainori from ariiacont KIi,l1A 1 t

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N o Q T M c ^ Post Office Box 3089
Topsail Beach, North Carolina 28445-9831
Telephone [phone]
Fax [phone]
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVE FORM
Name of Individual Applying For Permit I4 t 1 am Sc iry.e 5
Address of Property: 1 14 Chan 1 1 W d
`r �1 13eac e_,
(I t 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 provided with this letter.
I have no objections to this proposal.
If you have objections to what is beingproposedLplease write the Town of Topsail Beach,P.O. Box 3089,
Topsail Beach,N.C.284454-9831,or you may contact Jon Briggs,CAMA LPO Officer at 910-328-2708
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
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.)
• f I do wish to waive the 15' setback requirement.
4 I do not wish to waive the 15'setback requirement.
?- "t7 - - 9c-P
/More Date
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P t Name'll
elephone Number With Area Code

/Tow N OF 4
Bk
C.WOW.'LINA L.
N O R H G " R Post Office Box 3089
o
Topsail Beach, North Carolina 28445-9831
Telephone [phone]
Fax [phone]
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVE FORM
Name of Individual Applying For Permit: W 1'I am Jumps,
Address of Property: T 4 0-)6rInQA
a
(1.dt 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 provided with this letter.
I have no objections to this proposal.
If you have objections to what is being_proposed,please write the Town of Topsail Beach,P.O. Box 3089,
Topsail Beach,N.C.284454-9831,or you may contact Jon Briggs,CAMA LPO Officer at 910-328-2708
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
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.
a •� 5-zS - �
Sig e f Date
Z.
Print N re 5a - 71S
Telephone Number With Area Code