02226D - Hyman

CERTIFICATE OF EXEMPTION
FROM REQUIRING A CAMA PERMIT 022
as authorized by the State of North Carolina,
Department of Environment and Natural Resources and the Coastal Resource o mission
in an area of environmental concern pursuant to 15 NCAC Subchapter 7K, 1 �\ 3c
icant Name t'i ar\ �a� Phone Number, f !, 2 D`1
'ess 10 a,-
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_ Zipact L ation (Cqunty,,State Rpad, Wqter Body,, etc.S
and Dimensions of Project
roposed project to be located and constructed as described
is hereby certified as exempt from the CAMA permit
ement pursuant to 15 NCAC 7K. This exemption
MA permit requirements does not alleviate the necessity of
)btaining other State, Federal or Local authorization.
n
This certification of exemption from requiring a CAMA pe
valid for 90 days from the date of issuance. Following expi
a re-examination of the project and project site may be nec
to continue this certification.
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H : Panasonic FAX SYSTEM PHONE NO. : Jul. 28 2014 10:47PM P1
A 0211
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WUNR
North Carolina Departrn=nt of Environment and Natural Resources
lecrory John E, Skvarla. III
emor Secretary
AGENT AUTHORIZATION FORM
Date: 0710014
I of Property Owner Applying for Permit: Name of Authorized Agent for this project,
Susan Hyman Jonathan Tennant
ir's Nailing Address:
10 Bucldngham Way,
r, NC 27502
_susanhymanS "ail.com
9( M 971-9109 —
Agent's Malling Address:
1611 Stonc Chimney Rd. SW
Supply, NC 28462
Email: iontennantna EC.com
Phone i 010 ) 942-9973
fy that I have authorized the agent listed above to act on my behalf, for the purpose of applying
nd obtaining all CAMA Permits necessary to install or construct the following (activity):
replacement of floating dock
iy property located at _ 209 Lois Ave
Holden Beach, NC 28462
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CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OFCOASTALIA
- -- - -
__ ADJACENT RIPAR(ANpROPERLY-OWNER-NO-T-IFICATIONIWAIVER-FORM -
Name of Property Owner:
Address of Property:
ent'sTlame rc-iinnn "`.,�r, nn�- - -- Mailing Address: 11� 11
Agent's phone #: (QIO) Ie1'1-5451e S,. npk,. tQC. ZNc.,a
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.
�I have no objections to this proposal. I have objections to this proposal.
If you have objections to what is being proposed, you must noft the Division of Coastal Management (DCM) in
writing within 10 days of receipt of this notice. Correspondence should be malted to 127 Cardinal Drive Ext,
Wilmington, NC, 28405-3845. DCM representatives can also be contacted at (9f0) 796-7215. 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. '�fI(ov,Ca
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Signature
suscin ) 1N r,,. o CN
Pnnt or Type Arame
301O Suc. c"Ci r,orn WA.,
Mailing Address
n_ . , -
(Ad acent Prop9rPy Owner Information)
C
Signature
Print or Type Name
_:,1, I ► L , ,4
Mailing Address
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