69330D - Perez

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New 25ft float pilings
3ftxl bft aluminum ramp
New 20ftx 14ft,
stationary dock
existing
6fbx8ft finger pier' - existing bulk

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FORA PIER M'OORINGPILFNGSBOAT=IBOATHOUSE)
I hereby certify that I own property adjacent to Mr. Bill Perez is
(Name of Property Owner)
property located at 120 Salisbury
.(Lot, Block, Road, etc.)
an Canal , in_ Holden Beach N.C.
(Waterbody) (Town and/or County)
Applicants phone#- [phone] Mailing Address. 1912 Hillock Dr
Raleigh, NC 27612
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/mooring pilings / boatlift / boathouse
must be set back a minimum distance of fifteen feet (15� from my area of ripaaan access unless
waived by me. (If you wish to waive the setback, you must initial the appropriate blank
below.)
1412 not wish to waive
Initial here> I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
Reconstruction of existig docking facility.
(Information for Property Owner Applying (Riparian Property Owner Information)
for Permit)
3235 Seacrest Ave, SW
Mailing Address
_Supply, NC 28462
City/State&ip
Mr. Michael Gray
Signature
Print or Type Name
rim

itial here>
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERl1 tOORING PLUNGSIB OA T1-UTB OA THO USL�
I hereby certify that I own property adjacent to Mr. Bill Perez is
(Name of Property Owner)
property located at 120 Salisbury
.(Lot, Block, Road, etc.)
on Canal
(Waterbody)
in Holden Beach
(Town and/or County)
N.C.
.Applicant's phone #-. [phone] Mailing Adder: 1912 Hillock Drive
Raleigh, NC 27612
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/mooring pilings i boatlift / boathouse
must be set back a minimum distance of fifteen fed (15D 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 not wish to waive
I do wish to waive that setback requirement
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
Reconstruction of existing docking facility.
(Information for Property Owner Applying
for Permit)
3235 Seacrest Ave, SW
Mailing Address
Supply, NC 28462
City/State/Zip
Mr. James Herring
Information)
Signature
Print or Type Narne
[phone] 86 �3- a 6 j- 6 3 G 5
Telephone 13umbcr Authorized Agent Telephone Number

HCDEHR
North Carolina Department of Environment and Natwal Resources
Division of Coasiai Managemeni
Beverly Eaves Perdue ,fames K Gnm
G;verrar Dve coo(
'fee freeman
Secretary
AGENT AUTHORIZATION FORM
Date- Aug 21. 2017
Name of Property Owner Applying for Permit: Name of Authorized Agent for this project
Sib Perez
Owner's Mailing Address=
' 94 2 hoc', r)-
Raleigh. NC 27612
Phase Number ( 9191414-%75
'Yvili Rj&ardson
Agent`s Mailing Address:
3235 Seacrest Ave. SW
Supply NC 28462
Phone Number ( 9101 367-0335
certify that i have authorized the agent listed above to act on my behalf, for the purpose of applysng
for and obtaining all LAMA Permits necessary to instai; or construct the foltowng (activity)
ReoonsVuc +Or? of extstaino doCKM faO"
tmy prwerty �Ocatedj at -2c S'a%b'. , W se.&Ct' %C 284s"'Z
This cerW"tion is valid thru (cFate,� Feb 21. 2018
r
Property Owner Si6fiature Date