63234D - Hyatt

Date Received
Check From (Name)
Name of Permit
Holder
Check Number
Check amount
Permit Number/Comments
5/1/2014
Grice Construction of
Brunswick Co.
Hyatt/Bock
9591
$400.00
63234D-Hyatt & 63255D-
Bock
5/1/2014
NP Liles, Jr and JC Liles
6486
$200.00
63197D
5/1/2014
Town of Holden Beach
026332
$400 00
63251D
5/6/2014
Maritime Builders
Rodrigues
2657
$200.00
GP 63273D reissue 61596
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Division of Coastal Mgt. Habitat Impact Computer Sheet
)licant: Permit #: (p3Z3�AVI)
+
,cribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
nd in your Habitat code sheet.
kat Name
DISTURB TYPE
Choose One
TOTAL Sq. Ft.
(Applied for.
Disturbance total
includes any
anticipated
restoration or
temp impacts
FINAL Sq. Ft.
(Anticipated final
disturbance.
Excludes any
restoration
and/or temp
impact amount)
TOTAL Feet
(Applied for.
Disturbance
total includes
any anticipated
restoration or
temp impacts
FINAL Feet
(Anticipated fina
disturbance.
Excludes any
restoration and/<
temp impact
amount
Dredge ❑ Fill ❑ Both ❑ Other
�O�
2,/) 2
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
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North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Pat McCrory Braxton C. Davis John E. Skvarla,
Governor Director
Secretary
AGENT AUTHORIZATION FORM AGENT AUTHORIZATION FVKM
Date; �trl J—,/
lame of Property Owner Applying for Permit: N me of Authorized Agent for this project:
q—A Nc+1
,wner's Mailing Address: Agenit's M !n
r �-i Arr n
i
7 11
hone Number . LRty Phone Number
3 34, 76 J—- 1 -7 off-, .�
;ertify that I have authorized the agent listed above to act on my bi
r and obtaining all CAMA Permits necessary to install or construct
)r my property located at 4f' kv v v
its certification is valid thru (date)
Property Owner Signature
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Date

.. CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner: NN I r) W \A�AQ \T
Address of Property:
(Lot or Street #, Street or Rdad, City & County)
Agent's Name #:��(`1ZQ �SJ�c1S�� 1��t�rl Mailing Address: lid ,�
Agent's phone #: 1�1� ��1�i -�ilt 5 C)CQckn-Yi,` Q &-m&-, NC 2`5%C�
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 provided with this letter.
_Z71 have no objections to this proposal. __ T I have objections to this proposal.
If you have objections to what is being proposed, you must notify the Division of Coastal
Management (DCM) in writing within 10 days of receipt of this notice. Correspondence should be
mailed to 127 Cardinal Drive Ext., Wilmington, NC, 28405-3845. DCM representatives can also be
contacted at [phone]. 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, boathouse, lift, or groin must be set back a
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.
do not wish to waive the 15' setback requirement.
(Property Owner Information)
Signature
Print or Type Name
1AA-L � R�
Mailing Addre s
\ ty--\
City/State/Zip
(Adjacent Property Owner Information)
Slgi [ ZZYC'
Print or Type Name
HA- L- AK.
Mailing Address
wiL-KY 56c,I& , A1.e. 2y69 '7
City/State/Zip

10T

■ Complete items 1, 2, and 3. Also complete A. Signa m
item 4 if Restricted Delivery is desired. , X
■ Print your name and address on the reverse
so that we can return the card to you. tceived
■ Attach this card to the back of the m ' c@,Eh yor on the front if space permits. �er
1. Article Addressed to:+�,,
Fri 2) 7 914
iG � Servic
❑ Agent
�(Pxnte ame) D of [
1 address different from item 1 . ❑ Y `
iter delivery address below: ❑ No
ified Mail ❑ Ex ress Mail
Registered -turn Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes
2. Article Number 7p13 1,71� �0�� 34�7 0239
(Transfer from service label)
PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1540
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0
Iti
0
_ Postage
$
M
0 Certified Fee
[:3 Return Receipt Fee
O
(Endorsement Required)
t7
Restricted Delivery Fee
O (Endorsement Required)
Total Postage & Fees
$
Sent
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$3.30 14
$2.70 P sn n:uk
f iuie
$0.00
$6.49 1 jj2i24/2014
;n�(r�_1-1 r
l3 Sheet, t. �' � '
[� or POBoxN
-■ Complete items 1, 2, and 3. ATso complete
item 4 if Restricted Delivery is desired.
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
1(. Article Addressed to:
Yl1 C\(\ I � h-
See Reverse for Instructions
Ign ure
X El Agent
❑ Addressee
B. Receive y ( Printed Name) C. Date of Delivery
I`2c,.,
D. Is delivery address i!i eren 1? ❑Yes
If YES, enter'14very address b ❑ No
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