Hamilton, J. Nathaniel 77091C

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https://outlook'live.com/maiu0/inbox/id/AQQkADAwATy0MDABLwEwODAtymuw
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Agent's Name #:
Agent's phone #:
CERTIFIED MAIL . RETURN REgEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RTPARIAN PROPERTY OWNER NOTIFICATION/VI'AIVER FORM
Name of Property Owner:ilr
Address of Property:2a4 Qo,;.O.
(Lot or Street #, Street or Road, City & County)
Blr.-. ,^t-*o- t:,a,ltt*Mailing Address:o o q3
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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, wilh dimensions. must be provided with this letter.
I have no objectiorrs to this proposal. I have objections to this proposal.
lf you have obJections to what is being proposed, you must notify the Divislon oI Coastal Managetnent
(DCM) in writing within 10 days of receipt of this notice. Contact information for DCM offices is
availahle at http:llwww-negoagtalntanaqenls:ltLngt/-WgNcm/statl:lis-tinq or by calling 1-888-4RCOAST-
No resoonse is considered the same as no it vou have been notified bv Certtfied Mail.
fr<t*I do wish to waive the 15' setback requirement.
I do not wish to waive the 15'setback requirement.
n)(Ri Owner lnformation)
Pinl orType Name
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Mailing AddressMaitino
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Address
City/StatefZip
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W.eatW Telephone Number/ Email Address I
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(Revised Aug. 2014)
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, or lift must
be set back a minimum distance of 15'from my area of riparian access unless waived by me, (lf
you wish to waive the setback, you must initial the appropriate blank below.)
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ADJAcENTR*A*xliloRtS[-"flHfilltts?Ei##JNm^UERFoR,
Name of property Owner
Ager 's Name #:
Agent's phone #:
(Lot or Street #, Street
b" uJ-
or Road, City &County)
ailing Address;o B o. QC
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I hereby cediry that I own property
apply ing for this permit has d escr'M to
adjacent to th€ above referen ced property The individual
e developmenttheyare proposing me as shown on the attach ed drawi ng-th
I have no objections to this proposal.
lf you have objections to(DCn)in wrlting withtn
available at h
notlfy the Dlvlslon of Coasra/lltandgementContactlrrfoma on for DCM offices isNo,s the as ,,osame if vou have beon bv Centfied
otby ca lng I -88&1RCOAST.
Mail.
I understand that a pier, dock. wAlvER SECTIoN
oesetoacra-ml;i,ffi ,d;#J:?i!9fjHT.r'"".:#[tj;ii&1r,:.?j*ir;::,,lri:"],
you wish to waive the serback, you mugt innijt ffiillffilt blank betow.)t/ I do wish to waive the 15, setback requirement. ly*w 2.5ri?*:2_. 7r/a t
(P
I do not wish to waive the 15, setback roquirsment
rty Owner I
Signature
Pnnt or Typ e Name
Payt Dt-
Mailing Address
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City/Stateaip
Tel e Number /Addressfr-/Pilcx4/f>
iparian Pro Ownor lntormation)
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t or Type Name
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Mailing ,4ddl'sss
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Telephone
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Address
Dat
lar/(arL.Z*?t
Date
Lo
Email
(Revised Aug. 2014)
Address of property:
-
I have objcctions to this proposal.
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Name of Property Owner Requesting Permit:
AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
,(*il",-
a.1t Wo furhz.
Mailing Address
Phone Number:
Email Addres:
I certify that I have authorized
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G.reenv ri\{-\)c 2? P5(
2-< A- 31t - {se I
ohaynt\s@vteJ
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
t{crr Aoclc- o^4necessary
b
at my property located at ,_oa on^d Nl\cr*+.'. ko \,
CT L County
I fufthermore ceftW that I am authoized to grant, and do in fact grant permission to
Division of Coastal Management staff, the Local Permit Ofticer and their agents to enter
on the aforementioned lands in connection with evaluating information related to this
permit application.
Own
for the following proposed development
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Print ot Type Name
Title
OL ,o )- ,,2n2a
Date
This certification is valid through , ,
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