83-063_Hedrick, Dr. Thomas B_19831122 (3)

STATEMENT OF OWNERSHIP
RECEIVL
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I, the undersigned, an applicant for a CAMA minor development permit, being either the owner'of oI� rt in f
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an area of environmental concern or a person authorized to act as an agent for purposes of applying �J4/ 84
minor development permit, certify that the person listed as landowner on this application has a signific t interest
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in the real property described therein. This interest can be described as follows: (check one) `�_
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✓ an owner of record title, Title is vested in R 1 rt°Mh S (
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see Deed Book , page - in the
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County Registry of Deeds..
an owner by virtue of inheritance. Applicant is an heir to the estate of
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probate was in Count Y•
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if other interest, such as written contract or lease, explain below or use a separate sheet
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attached to this application.
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t f rthtrmore certi thatthe following perssns are owners of properties adjoining this property. I an' to
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apply for a CAMA permit
(Address)
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GSA°F. c r.'--j G� �L A AA- 1 k pD L,
(2) '7"'OLv.J u j- A G S f a D - . O Q
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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
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particular hazard problems associated with this lot. This explanation was accompanied by recommendations
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concerning stabilization and flood -proofing techniques.
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PERMISSION TO ENTER ON LAND
I furthermore certify that I am authorized to grant and do in fact grant permission to the local permit officer
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 31 day of
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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 V e. I t-10_,uir 5
Address C/ A A X 0--i j
City
2. AUTHORIZED AGENT
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State N- G Zip -.2-7259 Phone `r`�/-'��//�
Name / I&AiZvItJ Mtt,—, C.d
Address P. O . 15c),(
City IV Ac-s �4Gkp State Zip 2797 9 Phone
3. LOCATION/DESCRIPTION OF PROJECT c�r� 6,D� o = S/t't�c-'- STXC=z-
0-3 Oa
%U5.t.,c, t e ShND
4. AREAS OF ENVIRONMENTAL CONCERN (AEC) CLASSIFICATION
(To be filled in by Local Permit Officer prior to completing application.)
DE' —leff: Ocean Hazard Estuarine Shoreline Other
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5. PROPOSED USE
Residential Commerical/Industrial Other
G.-SIZE OF BUILDING IN SQUARE FEET: �J /A
7. SIZE OF SITE IN -SQUARE FEET:
NO, This application includes: general information (this This the 3I day of ,
F' form), a site drawing as described on the back of this
iapplication, 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- l W
' Applicant's signature (or authorized agent)
vided orally by the applicant. The details of the applica
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tion as described by these sources are incorporated
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without reference in any permit which may be issued. Indicate below address and phone if not shown above.
Deviation from these details will constitute a violation
lof any permit. Any person developing in an AEC without
1 a CAMA permit is subject to civil, criminal and admini-
strative action.
SITE i
SITE;
DATE
IS
OTHER PERMITS MAY BE REQUIRED...
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 ... drinking 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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TOWN OF NAGS HEAD
NAGS HEAD, NORTH CAROLINA 27959
CAMA PERMIT NOTICE
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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 October 31, 1983, Dr. Thomas Hedrick,
the applicant, proposed to push sand up from.the beach to fill in
an erosion scarp at Carolina Cottages, located on the north side of
-Small Street on the oceanfront 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 permit
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]
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For publication in The Coastland Times, November 8, 1983
Please use Nags Head logo and legal print.