83-073_Miciotto, Miles_19831128

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STATEMENT OF OWNERSHIP
I, the undersigned, an applicant for a CAMA minor development permit, being either the owner of property in
an area of environmental concern or a person authorized to act as an agent for purposes of applying for a CAMA
minor development permit, certify that the person listed as landowner on this application has a significant in T
in the real property described therein. This interest can be described as follows: (check one)��r
an owner of record title, Title is vested in I L r=s / _ JAN�3 ��9
� GloT7'o
see Deed Book , page in the �� '� [C
�A �= County Registry of Deeds.
an owner by virtue of inheritance. Applicant is an heir to the estate of
; probate was in
County.
if other interest, such as written contract or lease, explain below or use a separate sheet
attached to this application.
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NOTIFICATION OF ADJACENT PROPERTY OWNERS >
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I furthermore certify that the following persons are owners of properties adjoining this property. I affirm that
have given ACTUAL NOTICE to each of them concerning my intent to develop this property and to apply for
a CAMA permit.
�. NN AName) (Address)
(1) ~APB Get
(2) tl ni f� A a � � 0 LU a G.D ko�c-r�fr n l rfc,:
(3)
(4)
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FOR DEVELOPERS IN OCEAN HAZARD AND ESTUARINE SHORELINE EROSION. AREAS:
acknowledge that the land owner is aware that the proposed development is planned for an area which may
be susceptible to erosion and/or flooding. I acknowledge that the local permit officer has explained to me the m
particular hazard problems associated with this lot. This explanation was accompanied by recommendations 3
concerning stabilization and flood -proofing techniques. =4
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PERMISSION TO ENTER ON LAND 3
furthermore certify that I am authorized to grant and do in fact grant permission to the local permit officer o
and his agents to enter on the aforementioned lands in connection with evaluating information related to this
permit application.
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This the day of , 19
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Land owner or person authorized to act as his agent
for purposes of filing a CAMA application.

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GENERAL INFORMATION
1. LANDOWNER
Name /i1 /Li:S' All C/ci7-6
Address 31
City V 16
I—AT/CiC A 57- 5. UJ
State VA - Zip <7-1 u°a Phone
763 -560 -i 6en �4
2. AUTHORIZED AGENT
Name'/1�- iy • I�rC/tA�N�s
Address c x �� U
City /V i4 C-5 7 r:714.0 State �"' 6— Zip i3 l Phone Cl-S�/—"'4C��
3. LOCATION/DESCRIPTION OF PROJECT L ` r 'A1r_ GA 4. A
's cvi t4 k/AG5 /Ckv
4. AREAS OF ENVIRONMENTAL CONCERN (AEC) CLASSIFICATION
(To be filled in by Local Permit Officer prior to completing application.)
V Ocean Hazard Estuarine Shoreline Other
5. PROPOSED USE
Residential Commerical/Industrial Other
6. SIZE OF BUILDING IN SQUARE FEET: %G6,c, S, r ,i 36, 5-. F P er64 / N C,
7. SIZE OF SITE IN SQUARE FEET:
This application includes: general information (this
form), a site drawing as described on the back of this
application, the ownership statement, the AEC hazard
notice where necessary, a check for $25.00 made payable
to the locality, and any information as may be pro-
vided orally by the applicant. The details of the applica-
tion as described by these sources are incorporated
without reference in any permit which may be issued.
Deviation from these details will constitute a violation
of any permit. Any person developing in an AEC without
a CAMA permit is subject to civil, criminal and admini-
strative action.
OTHER PERMITS MAY BE REQUIRED...
T/t
This
he day of c�(y
/%!c�'6i�i«.cam
Applicant's signature (or authorized agent)
Indicate below address and phone if not shown above.
The activity which you are planning may require permits other than the CAMA minor permit you are applying
for here. As a service we have compiled a listing of the kinds of permits which might be required. We suggest that
you check over this list with your Local Permit Officer to determine which, if any, of these may apply to your
project. This is not a requirement of CAMA, only a suggestion to help you complete your project as quickly as
possible.
zoning.. Arinking water well. ..'septic tank (or other sanitary waste treatment system). .
burning ... electrical ... plumbing ... heating and air conditioning ... insulation and energy
conservation ... FIA certification ... sand dune ... sediment control ... subdivision approval
...mobile home park approval ... highway connection. ..others:

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Bldg. Inspectors
DARE COUNTY HEALTH
DEPARTMENT Copy
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THIS PERMIT
IMPROVEMENT PERMIT (SEPTIC TANK SEWAGE DISPOSAL) ,
GOOD FOR ONLY NOT TRANSFERABLE " 1583
180 DAYS
'
DATE OF APPLICAT N .
S H WATER TABLE to /
NEW: Trl. - House = Bus. EXISTING: TrI. • House • Bus. -,
SOIL. STRUCTURE Suitable Unsuitable
----� :.
�,
rovis on ally Suitable_,`:-•
LOT 81ZE
SOILTEXTURE Suitable Unsuitable
PROPERTY OWNER �oTTd "'
Provisionally Suitable
ADDRESS "313 �t1TjQltiC ST• "S CtJ• i%IE'.i/.�'A `Y�i
7 PERCULATION RATE. J LA ­
LO TION* 2 e y r le C_ Alf-- �f✓ � -
RESTRICTIVE HORIZONS ,.d 1 At "'
•�
1-1 >! tol. ,t/. C -
SLOPE
TYPE OF TANK: Pit f P AS r SIZE OF TANK: 10510
DISTANCE FROM SURFACE WATER
AMOUNTOFTILE —WIDTH OF DITCH
-- DISTANCE FROM "SA" WATER A)
ROCK UNDERTILE - (� WATER; Private - -
PLAT WITH SKETCH ATTACHED
ABOVE TILECity.
" SEWAGE CONTRACTOR �"
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PERMIT ISSUED BY Sanitarian
NOTE This permit Is Issued subject to all provisions of the ordinance governing the In
{ staliation of septic tank systems. THE PERSON MAKING SAID INSTALLATION MUST
1:
1 NOTIFY THE HEALTH DEPARTMENT WHEN THE SEPTIC TANK SYSTEM IS READY
FOR INSPECTION. If any septic tank system or part thereof Is covered before being In.
spected and approved, It shall be uncovered at the direction of the Health Officer at the
expense of the one responsible for making installation
_ .
Maintain Minimum 10 Ft. from All Property Lines & Water lines
Maintain Minimum 100 Ft. from All Wells
Signature of property owner or authorized agent. (Jointly responsibls)
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TOWN OF TAGS TAD
NAGS HEAD, NORTH CAROLINA 27959
CA*LA PEP -MIT NOTICE
Pursuant to NCGS 113A-119(b), the Town of Nags Head, a locality
authorized to issue CAMA permits in areas of environmental concern,
hereby gives NOTICE that on November 28, 1983, Miles Miciotto, the
applicant, proposed to erect a single family dwlling at lot 4,
McCall Court in south Nags Head, in an ocean hazard AEC.
Persons desiring to inspect the application, to comment thereon or_
to appeal the local decision are directed to contact the local per-
mit officer at the address below.'
M. Edward Harrell
Receiving Minor Development
Permits under CAMA
Address: P. 0. Box 99
Nags Head, N. C. 27959
Telephone: [phone]
For publication in The Coastland Times, December 6, 1983
Please use Nags Head logo and legal print.