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Lyn Small Inc. Marine Construction
AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: _Robert Brace
Mailing Address: 190 Dowdy's Bay Rd, Grandy
Phone Number: 252-597-4032
Email Address: rbrace50@Vahoo.com
I certify that I have authorized Lyn Small Inc
Agent ( Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: _Install boat lift,pilings and
dock
at my property located at 190 Dowdy's Bay Road, Grandy_
in Currituck—County.
I furthermore certify that I 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:
p Signature
�}} Print or Type Name
t 0o ec
Title `
This certification is valid through�l,l
Date
This certification is valid through �2,1�/!,�',
CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner: Robert Brace
Address of Property: 190 Dowdy's Bay Road, Grandy
(Lot or Street #, Street or Road, City & County)
Agent's Name #: Lyn Small, Inc
Agent's phone #: 252.491.8562
Mailing Address: 113 Ballast Rock Dr
Powells Point, NC 279%
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
th7have
posing. A description or drawing with dimensions must be nrovioed with this letter.
no objections to this proposal. _ I have objections to this proposal,
If you have objections to what is being proposed, you must notify the Division of Coastal Management
(DCilf) in writing within 10 days of receipt of this notice. Contact information for DCM offices is
available at i ifs?�W v.Lacc � ;� lrs�sn�r� rerr<. t� a or by calling ?-U8.4RCDAST.
No response is considered the same as no obl_ction r7'you hello been notlfied by Certified Mail.
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 a unless waived by me. (If
you wish to waive the setback, you must initial the appropriatq blank. low.) og� _ I d
TJwao wish ive , 5' setback requirement. L�
C,44
(Property Owner Information)
Signature
Robert Brace
Print or Type Name
190 Dowdy's Bay Road,
Mailing Address
Grandy, NC 27939 r
CityVState2ip s
Telephone Number/Email Address
Bate
ive the 15' setback requirement.
(Riparian Prope Owner Information)
signatuiel
Peggy Holmes
Print or Type Name
3925 Ocean Cut Lane,
Mailing Address
HeAdewAm
6 7`53ti 1 `jirrF ? ?{i'C `t t V I.
cilyntatwvp
Telephone Number/ Email Address
(Revised Aug. 2014)
CERTIFIED MAIL - RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner: Robert Brace
Address of Property:
Agent's Name #: L
190 Dowdy's Bay Road, Grandy
(Lot or Street #, Street or Road, City & County)
Small. Inc Mailing Address: 113 Ballast Rock Dr
Agent's phone #: 252.491.8562
Powells Point, NC 27966
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 notify the Division of Coastal Management
(DCM) in writing within 10 days of receipt of this notice. Contact information for DCM offices is
available at http://www.nccoastaimanagement.netlweblcrnlstaff-listing or by calling 1-888-4RCOAST.
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, 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. (If
you wish to waive the setback, you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Signalure
Robert Brace
Print or Type Name
190 Dowdy's Bay Road,
Mailing Address
Grandy, NC 27939
CitylStatelzip
Telephone Number/Email Address
Date -
(Riparian Property Owner Information)
Si gnat tcr-�r
Jim Wyatt
Print or Type Name
1809 Peace Street
Mailing Address
Henderson, NC 27536
CitylStatelzip
Telephone Number/Email Address
Date
(� Sa (Revised Aug. 2014)
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Currituck County GIS Online Mapping /
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Addresses
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Aerial Photography (201
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tuck County GIS Thi map should be used for general reference purposes only.
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