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CERTIFICATION OF EXEMPTION FROM REQUIRING A CAMA PERMIT as authorized by the State of North Carolina, Department of Environmental Quality and the Coastal Resources Commission in an area of environmental concern pursuant to 15 NCAC Subchapter 71<10-0 or NCGS 113A-103(5)(b)(5) - Applicant Name j dP 5+ -lu r' y i Phone Number Address I`. 0- A =,c A,G . ; City State AI& Zip Project1 Location(Cou ty,State Road,Water Body,etc.) prr'� �`� ��'' � � �; �`'.� ✓'T 1 T pe and Dimensions of roje t � ''`ti !c. t 4 ✓, y,'-� The proposed project to be located and constructed as This certification of exemption from requiring a CAMA permit described above is hereby certified as exempt from the is valid for 120 days from the date of issuance.Following CAMA permit requirements.This exemption to CAMA expiration,a re-examination of the project and project site may permit requirements does not alleviate the necessity of be necessary to continue this certification. your obtaining any other State,Federal,or Local authorization. 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Issuing date Expiration Date CERTIFICATION OF EXEMPTION FROM REQUIRING A CAMA PERMIT as authorized by the State of North Carolina, Department of Environmental Quality and the Coastal Resources Commission in an area of environmental concern pursuant to 15 NCAC Subchapter 7K,jmfor NCGS 113A-103(5)(b)(5) Applicant Name wP S+ Pat t 1� Phone Number a 52 -217 -YO/7 Address P. o, Box a d AQ ; City A :iL1A,e —,-c be'r,CA State Al Zip99Sl2 Project Location(Cou ty,State Road,Water Body,etc.) T pe and Dimensions of Proje t rc O ` ,'n -SV, c' ,`` C 11, 4 fit' v✓6'1 ,' e ✓ The proposed project to be located and constructed as This certification of exemption from requiring a CAMA permit described above is hereby certified as exempt from the is valid for 120 days from the date of issuance. Following CAMA permit requirements. This exemption to CAMA expiration,a re-examination of the project and project site may permit requirements does not alleviate the necessity of be necessary to continue this certification. your obtaining any other State, Federal, or Local authorization. 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CAMA Official's signature The applicant certifies by signing this exemption that the ��%�1 �. 0�J"�AA applicant will abide by the conditions of this exemption. Issuing date Expiration Date AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION Name of Property Owner Requesting Permit: Mailing Address: Phone Number: 2-q7-Itb►7 Email Address: yr 4 W, I certify that I have authorized (Z -►.�.'� �ervw� a-�•�> tiorw� ( ..� Agent/Contractor to act on my behalf, for the purpose of applying for and obtaining all CAMA permits necessary for the following proposed development: ot0 Seca... \\ at my property located at '5n o in QXA-4cx County. l furthermore certify that 1 am authorized to grant, and do in fact grant permission to Division of Coastal Management staff, the Local Permit Officer and their agents to enter on the aforementioned lands in connection with evaluating information related to this permit application. Property Owner Information: Signature Print or Type Name &t"�X"j Title Date RECEIVED Illl. 2. 4 2024 This certification is valid through i2 / 31 / A 5- DCM-MHD CITY N.C. DIVISION OF COASTAL MANAGEMENT ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM CERTIFIED MAIL - RETURN RECEIPT REQUESTED or HAND DELIVERY (Top portion to be completed by owner or their agent) Name of Property Owner: M-7, I GwcK Address of Property: 3 7U Co rt..X br~tt_ �.ac �� SLp^&, N.C. 29S rL Mailing Address of Owner: ?U. &-.t gpzk, AaI� ,,J.c- 21tsit Owner's email:cf�11..rc�ir,rr,�., Lv--% Owner's Phone#: ILt -TS16- S33'G Agent's Name: berr:S•t-S.^ o*4-, L-. Agent Phone# 25�-2�tt-(Fi'1 L Agent's Email: b5fro-u-G�1',G cv,— ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION (Bottom portion to be completed by the Adjacent Property Owner) 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 must be provided with this letter. >� I DO NOT have objections to this proposal. I DO have objections to this proposal. if you have objections to what is being proposed, you must notify the N.C. Division of Coastal Management(DCM) in writing within 10 days of receipt of this notice. Correspondence should be mailed to 400 Commerce Ave.,Morehead City,NC 28557.DCM representatives can also be contacted at(252)808-2808. No response is considered the same as no objection if you have been notified by Certified Mail. WAIVER SECTION understand that any proposed pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or groin must be set back a minimum distance of 15'from my area of riparian access unless waived by me (this does not apply to bulkheads or riprap revetments). (If you wish to waive the setback, you must sign the appropriate blank below.) I DO wish to waive some/all of the 15'setback zg,g t.J./-+Q-OR- oL-- Signature of Adjacent Riparian Property Owner I do not wish to waive the 15' setback requirement(initial the blank) C>4% Signature of Adjacent Riparian Property Owner: A;IC,dL-- Typed/Printed name of ARPO: CMt,,�GJ.Ftia�-� T�eas�.rer �cace� �Reoc1-. n'b*�� Mailing Address of ARPO: QSM 11 AAA A - ger c�, A.C 2A,51"t- ARPO's email: ARPO's Phone#: V52-2-�-7-4a-7 Date: *waiver is valid for up to one year from ARPO's Signature* RECEIVED Revised July 2021 1111 2 4 2024 DCM-MHD CITY N.G. DIVISION OF COASTAL MANAGEMENT ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION[WAIVER FORM CERTIFIED MAIL - RETURN RECEIPT REQUESTED or HAND DELIVERY (Top portion to be completed by owner or their agent) Name of Property Owner: H. --Qc-. f Cluck i'u1�t7-* PR-ti, „(_ Address of Property: C="rw%, ray �rw1� S ry 4C.. 2*5-'12- Mailing Address of Owner: 4,e0„� Ail.+K eo.d. N,C. 246"iZ Owner's email:_ C FvL�erLe pwner's Phone#: Agent's Name: 17a wv.%, So.Y+ t`{�t,.•rc i�.K4, 1-4f- Agent Phone#: 252. 911- L9i(.2 Agent's Email: b-sma w c<P G..A-C.,-. ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION (Bottom portion to be completed by the Adia gllt Property Owner) 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.must be g-rovided with this letter, I DO NOT have objections to this proposal. I DO have objections to this proposal, if you have objections to what Is being proposed, you must notify the N.C. Division of Coastal Management(DCM)In writing within 10 days of receipt of this notice. Correspondence should be mailed to 400 Commerce Ave.,Morehead City,NC 28557.DCM representatives can also be contacted at(252)808-2808. No response is considered the same as no objection If you have been notified by Certified Mail. WAIVER SECTION I understand that any proposed pier,dock, mooring pilings,boat ramp, breakwater,boathouse, lift,or groin must be set back a minimum distance of 15'from my area of riparian access unless waived by me (this does not apply to bulkheads or riprap revetments).(If you wish to waive the setback,you must tam the appropriate blank below.) I DO wish to waive some/all of the 15'setback -OR- Signature of Adjacent Rlparian Property Owner 1 do not wish to waive the 15'setback requirement(initial the blank) Wd b Signature of Adjacent Riparian Property Owner: Typed/Printed name of ARPO: �c�-re+a "J;.,. �1act��,r.ce,.� t ►,��,,.�1rC , Mailing Address of ARPO: rsl I ARPO's email: y b 1 &bd c A-carN ARPO's Phone#: a Act Date: -7t UN2.y *waiver Is valid for up to one year from ARPO's Signature* Revised July 2021 RECEIVED J U L 2 4 2024 DCM-MHD CITY ' K �' APP.90'®F NtMI IN FRONT�EXISTIaG L AD �IF �. QJ Awl "o � s . 4*1 .+ L