Plautz

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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.
Applicant Name JP1-fr-le 1" l LCi .- Phone Number
Address as52 a n�rA ©AV-% -Mud
City r 'i r• State NO Zip.2:la 1.5''
Project Location(County, State Road,Water Body, etc.) � j . I i
At„ ,:le.._. of ttVI) SOw- , NOrii-N_ o�s�� c(,, i St-urr ? __50v,rd
Type and Dimensions of Project i� d ac c.k_. Si}-{� c1 M Q r, �% 11 n S
N\us. �,�. C (Ns a ' tired',A ie. �f t,.'.�r4 ' Mir k c'n s. .
k �dcc 04. uJ A. 'r
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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ifAny person who proceeds with a development without the con- � K
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 •
development. C A icial' signature
a , 1990
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, ' ,�
and(2)a written statement has been obtained from adjacent

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER)
•
I hereby certify that I own pro`perrty .adjacent to
/-0.MC , 'PJoLc, 2 a 5lita t A nv tIor •P(cu z- 's property located at
(Name of Property Owner)
Lef ./ ; 1 (13 old Vi1( e- L Jtt- ;
(hot, Block, Road, etc. ) ,�
on S So c id al�.v[GL in TD ,�s( 1 c1�'i , N.C.
(Waterbody) (Town dad/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.
V I do not wish to waive that setback requirement.
I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual 'proposing development)
Caul 12-'
Intl]
Core /' P(cudd j' Foo16s
La LIJf e i L 0z
1 Signature
15 -f°o-+- of-ba,k 7 naJd and Jur56 l%00%s
« t. Print or Type Name
L/10 Goff - 33 ��-
Telephone Number

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• ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER)
•
•
i hereby certify that I own pro`perrty .adjacent to
Gl.i'Y v1
1G5 PZ Q�10f f �IQ YDh �G(,U�tT 'n$G• 's property located at:
(Name of Property Owner)
l-Of 210 ') ) 9'3 old V i I(ace La-a— - ;
( t, Block, Road, etc. ) �"
on S'hU 4 so cgid (� in 'V0 i-h To0Sct,�( ( LCI1 , N.C.
(Walterbody) (Town sand/or County)
He has described to me, as shown below, the development he is
-nroposirr, 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.
1.
' I do not wish to waive that setback requirement.
. I do wish to waive that setback requirement.
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DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To' be filled in by individual proposing development)
CA'ta-f Z' ,,...�
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Core P(cuc tz_ "7 F00%s
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Signature
5 -Foot 56fbctdc . j evrr a/ikof .`Z,Kdru ()oft
t�inkmven Print or Type Name
Telephone Number