LD-175 (rev. 05/16/03) Page 1 of 4
State of Hawaii
Land Division
SHORELINE CERTIFICATION – APPLICATION FORM
The attached Application Form is for persons requesting a shoreline certification.
Please note the following important points:
1) Please refer to Chapter 13-222, Shoreline Certifications, Hawaii Administrative Rules,
when applying for a shoreline certification. You can find these rules at our website:
https://dlnr.hawaii.gov/ld/rules/
2) A fee of $75 must accompany your application. This fee may be waived for federal,
State and county projects. This fee will be returned only where the application is
withdrawn prior to the Department initiating its review for completeness.
3) You will be responsible for reimburs
ement of any costs incurred by the State for
processing
of the shoreline certification, such as travel costs for site inspections. We will
inform you of these costs when we notify you of the State Land Surveyor's proposed
certificat
ion or rejection. You must remit payment prior to the Department releasing the
signed shoreline maps.
4) The processing of shoreline certifications is subject to automatic approval. If the
Department fails to render a decision on an application within 90 days from our
acceptance of a completed application or the expiration of any extension granted, then
the shoreline application shall be deemed certified. We will inform you of the
commencement and completion dates.
5) If you find an encroachment during the shoreline survey, we recommend that you do not
submit a shoreline application but rather contact the Land Division District Branch in the
applicable county to resolve the encroachment. Shoreline applications will be rejected
where encroachments are found.
6) Pursuant to §13-222-26, HAR, persons or agencies meeting certain criteria have
standing to appeal any proposed certification or rejection within 20 days of the OEQC
publication
. If you would like to file an appeal, please refer to the administrative rules
and the Department's "Shoreline Certification – Notice of Appeal " form.
All applications must be complete to be considered for processing. Please submit your completed
application form or direct questions to:
Land Division
1151 Punchbowl Street, Room 220
Honolulu, Hawaii 96813
Phone: (808) 587-0446; Fax: (808) 587-0455
Please do NOT send your application to our neighbor island District Branches.
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For DLNR use only
:
Case file no.:
STATE OF HAWAII Date application recvd:
DEPARTMENT OF LAND & NATURAL RESOURCES Date applic. complete:
Completion date (+90):
1st OEQC notice:
SHORELINE CERTIFICATION 2nd OEQC notice:
APPLICATION FORM Date appeals due (+20):
Date briefs due:
Date of decision (+60):
I. APPLICANT/AGENT
Applicant means the person submitting an application for shoreline certification.
Applicant name:
Applicant address:
Phone numbers: ( _) ( )
Phone Fax E-mail
II. PROPERTY OWNER
Property owner means the equitable or legal holder of interest in, or the lessee holding under a recorded
lease for the property for which a shoreline certification is requested, or the authorized agent.
Owner name:
Owner address:
Signature:
Date:
III.
LOCATION AND ADDRESS
Island
: ( ) Oahu ( ) Kauai ( ) Molokai
( ) Hawaii ( ) Maui ( ) Lanai
Town, District
: Tax Map Key:
Address
:
IV. PURPOSE
State the purpose for which the certification is being applied:
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V. CHECKLIST OF ENCLOSURES
( ) At least three (3) sets of color photographs of the shoreline, in accordance with §13-222-8,
HAR:
( ) Shoreline, as delineated on the map, is indicated on each photograph.
( ) Permanent markings on the ground or flaggings are indicated on the photographs.
( ) Each photograph is labeled by number or alphabet to coincide with the map showing
the direction the photograph was taken.
( ) Photographs provide accurate perspectives of the shoreline in relation to permanent
markings or other land features.
( ) Each photograph is marked with the date and time taken.
( ) At least seven (7) maps of the shoreline, in accordance with §13-222-9, HAR:
( ) Maps are on whiteprints and are one of the following sizes (in inches):
8.5 x 13, 10 x 15, 13 x 23, 15 x 21, 21 x 32, 22 x 36, 24 x 36, 30 x 36, 36 x 42, 42 x
42-72.
( ) Maps are drawn using an engineer or architect scale, in units of feet. Scale is clearly
noted on the map. No reduced or enlarged maps allowed.
( ) Maps are based on an actual field survey conducted within the prior 90 days.
( ) Maps have the licensed surveyor's seal and testament indicating the work was done
by the surveyor or under the surveyor's supervision.
( ) Maps indicate true north pointing towards the top.
( ) Map title and reference to location include the original source of title and name of
awardee, patentee, or grantee and the ili, ahupuaa, and the TMK and the property
owner's name and address.
( ) Maps show all permanent identification marks established on the ground and all
pertinent azimuths and distances.
( ) Maps indicate the type of shoreline being determined (i.e., vegetation line, debris
line, upper reaches of the wash of waves, face of artificial structure, or combination).
( ) At least two (2) of the maps show the direction the photographs were taken and the
point or shoreline depicted in the photographs.
( ) Field survey was conducted on
by .
( ) The licensed land surveyor who made or supervised the field survey was:
Name
Address
Phone no.
( ) Application fee of $75 is enclosed.
( ) Statement signed by property owner granting the State of Hawaii the right to enter the
property.
( ) Statement(s) signed by applicable owners granting the State of Hawaii the right to enter
land not owned by the property owner necessary for access.
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( ) Copy of any federal, State or county enforcement or other legal action involving the
subject shoreline.
( ) If shoreline is being located at the base of a manmade structure, copy of all documents
supporting that the structure has been approved by the appropriate government agencies
or is exempt from such approval.
VI. CERTIFICATION
I hereby certify that the statements and information contained in this application, including all
attachments, are true and accurate to the best of my knowledge and understand that if any
statements are shown to be false or misrepresented, this application may be rejected. Further, I
understand that the Department may review any shoreline certification during its 12-month
validity period and may rescind the certification where there is substantial misrepresentation or
material fact in the application, whether intentional or unintentional, as determined by the State
Land Surveyor or the Department.
Printed Name Date
X
Signature
