84-0017_Forr, David M. & Nancy A._19840302 (3)

►, �� APPLICATION
,
\lip FOR
' Y
,
, k CAMA
�
EVELOP_MENT
t IT
_ :) PER
's ^
x 1n 1974 e N rt CaroUnakGeerasser�ra€'
t : r
k ', bly passed tP Coastal Area M4rgemen ct
r� :and setthe stage or guidJng d vQlo rnent n
y
_, ffthe fragile arjc p�oductive_areas•wi bor e"r
noceanfron
:the state s esuanes, soundsa`d t'
"'"Along -with' egdjr ni g„sp„gc�alore by those��' �
ho build and �leve�op, th ;General Assembl
� ." ,. i
directed`the_Coas aLResourcesCpmmissidrsto r
,Arn, er j ntcle t rlgulatibn which minimize
the burden n tie applicant.
�_�for. mmo d to e t per -
'is
w+� h.! aPPhcatto j , n �� %
it under C, A as part of C� miss on's
`t A effo�toto 9)q t the spirt anc Intent of the
,.
- - - enerahAssemby It,ha"s been designed'to be
straightforward'an� require nomore time or
L effort thanFnecp sary, frome the applicant. e
E �., i Please go tern is folder with the,Local
"° Permit Officer�for t e locality in which yob
e. . � k
j plarr#o build to be ee tatmyvu-under- .
stand what irtforro' tion�he:u she eetis.
UnYr LAMA rua ions the minor permit
. .. �,e, -
i o e rssued within days once a complete��
a pl in han ten less time is needed
the project is situp e. The process generally
6kes about 18 days l ou can help speed the
4pprovafi process b� rking certain that your
?lrcapo`h is compi� and signed, that your
drawingmeets,the's a ifications given inside
"4 " "andlAharr6u Ap I cation fee is attached.
Other permits a
ri sometimes required for
development in th�4 stal area. While these
" ``' otCAMA�rel' ed, we urge_you to check .
'w4thxthrtmilPermitOfficerto retermi .e_
hicl�of these you may need. A "listing1s,- :
_._
- ............ included n pag-of the -#older
,.�
f. •^'�""' ` We appreciate your cooperation with the
North_.Carolina coastal management program
Q and your willingness to build in a way which
� -
..
pr-otocts the resour
ces of our beautiful an
productive coast - fi '�-
" -Coastal Resources Commission
o Coastal Ma _ fice f Co nagement
x.
fU

GENERAL INFORMATION
1. LANDOWNER
Name 0'
Address
' &,4)
City f��4��l.L State Zip _ �� � 0 � Phone 437:�,
2. AUTHORIZED AGENT
Name
Address 2_0 • C]6IC /06
U V
CJ
City 5!— State
Zip -47 Phone C'_57)"/ -1
3. LOCATION/DESCRIPTION OF PROJECT J �%T�/J'YD�IYGL X>GCS lJr eA
4. AREAS OF ENVIRONMENTAL CONCERN (AEC) CLASSIFICATION
(To be filled in by Local Permit Officer prior to completing application.)
Ocean Hazard Estuarine Shoreline Other
5. PROPOSED USE
Residential Commerical/Industrial Other
6. SIZE OF BUILDING IN SQUARE FEET: ItOoZy
7. SIZE OF SITE IN SQUARE FEET: — l4 7h -r
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...
This the day of 2AA ,
1904-.
CZ�C-A��
Applicant's signature (or authorized a ent)
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 ... 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:

Local Government
94.. o,e
Permit Number
CAMA
MINOR DEVELOPMENT
PERMIT
as authorized by the State of North Carolina, Department of Natural Resources
and Community Development and the Coastal Resources Commission for develop-
ment in an area of environmental concern pursuant to Section 113A-118 of the
General Statutes, "Coastal Area Management."
issued to David M. & Nancy A. Forr
authorizing development in DUCK , at Lot 98, Carol i na Dunes
Subdivision as requested in the permittee's application dated _- Febmary 8' 1Q84
This permit, issued on March 2, 1984 , is subject to compliance with the application and site drawing
(where consistent with the permit), all applicable regulations and special conditions and notes set forth below. Any violation of these
terms may subject permittee to a fine, imprisonment or civil action; or may cause the permit to be null and void.
All development must be in accordance with attached applications and
plats.
This permit action maybe appealed by the permittee or
other qualified persons within twenty (20) days of the issuing
date. From the date of an appeal, any work conducted under this
permit must cease until the appeal is resolved.
This permit must be on the project site and accessible to the
permit officer when the project is inspected for compliance.
Any maintenance work or project modifications not covered
under this permit require further written permit approval.
All work must cease when this permit expires on
March 1. 1987
In issuing this permit it is agreed that this project is consis-
tent with the local Land Use Plan and all applicable ordinances.
This permit may not be transferred to another party without
the written approval of the Office of Coastal Management.
Local Permit Officer (signature)
Field Services Consultant
Nelson G. Paul
Office of Coastal Management name
108 South Water Street
Elizabeth City, N. C. 27909
[phone] address
Permitee (signature required if special conditions above apply to permit)

'yLA R f TOC4K SOUND
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Ph 9E7T SO1c'28'00"E '.....�
PIN
N. C. S. R. (601R/W) # 1200
-0-p PIN
LOT SURVEY
FOR: DAVID M. 0 NANCY A. FORR
CARQ���'•
OF: LOT 98, SECTION "B"
S.+�`�� .»»•..ti�j,;'.,�
S. \STcR�� y ••,
CAROLINA DUNES
��
M
ATLANTIC TO'A'h'SHIP, DARE COUNTY, NORTH CQROLINA
Geor pc Yt' bc✓S;ttte, Jr.,R.L S , c4r1"`y that this C•at sot drern from an octual flsld bnd survey;
G7
,at t!,c error of ct.-4-jrt os cok;uta!a..', by b!h�Sryt cr.0 Csj-4nunna Is I lO,rXjO; shot It woo prtparrrd
occ
:�f%.-ti:'� n. _,,:.�.;��.a•
, :c ice rItt� G.S 47.50 ct omatiOd.
'Itr•a.a1 in)t�anQ anC tsal this II th. OCTOBER A.D. Ig83 �
_ ._day of _ 21
4. �����-�
4 .i::;�c:►'ss
GEORGE W k'.1�X�E1-7E, JR., LAND SURVEYOR
- I'"TH CAROL !NA AND VIMNIA
P O KX -�6 / K I, TY HAWK, N C. 27 94 9
TE l r P;s:►-C (9.91-,1741
�titi,E: (uB 6, 1•G `9) tail
D (A:ICFER 10,t.-• S

OFFICE OF
COASTAL MA
North Carolina Department of Natural Kenneth D. Stewart
DirectorResources &Community Development
€� James B. Hunt, Jr., Governor Joseph W. Grimsley, Secretary Telephone [phone]
r
Field Services
108 S. Water Street
Elizabeth City, NC 27909
[phone]
CIDASILAND MES
P.O. Box 428
Manteo, North Carolina 27954
Gentlemen:
Please include the enclosed Notices of Filing in the Public Notice section
of the Tues.. Feb 21 edition of your newspaper. If it will not be
possible to include these notices in that edition, or if you s1 uld have
any questions about these notices, please call me as soon as possible at
338-0206.
The State Office of Budget and Management requires an Affidavit of
Publication prior to payment for newspaper advertising. Please send these.
affidavits, copies of the published notices and the bill to Marcy Bunting,
Office of Coastal Management, Department of Natural Resources and
Coit><nity Development, P.O. Box 27687, Raleigh, N.C. 27611-7687.
Thank you.
Cordially yours,
Nelson G . Paul
Coastal Management Consultant'
NGP/aht
Mr. Richard K. Harr s ��
Mr. David M. Forr{
P. O. Box 27687 Raleigh, N. C. 27611-7687
An Equal Opportunity Affirmative Action Employer

CAMA PERMIT NOTICE
Pursuant to NCGS 113A.119(b), the North Carolina Department of
Natural Resources and Community Development, Office of Coastal Manage-
ment, the State agency authorized to issue CAMA minor development
permits in areas of environmental concern of unincorporated portions
of Dare County, hereby gives NOTICE that on February 13, 1984,
Mr. David M. Forr,.the applicant, proposed to construct a sound -
front residential structure at Lot 98 at the Carolina Dunes Subdi-
vision located in Duck, Dare County.
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 below address:
Mr. Nelson G. Paul
Local Permit Officer
Office of Coastal Management
108 S. Water Street
Elizabeth City, N. C. 27909
Tele: [phone]

s
f
REALTY
PHONE [phone]
P.O. BOX 130 • MILEPOST 101/2 • RT. 158 BY-PASS • NAGS HEAD, N. CAROLINA 27959
February 10, 1984 RECEIVED
FEB 13'84
Mr. Vida E. Bailey 0CM - EC
3620 Darby Rd
Brynmawr, Pa. 19010
Dear rr Bailey,
Dare County tax records indicate you to be the owner of Lot 99, Carolina
Dunes.
Mr. David Forr is the owner of adjacent Lot 98, Carolina Dunes and is
contracting Nags Head Realty to build a 1020 square foot one story dwelling
with three bedrooms and two baths on his lot.
Since sound front properties are subject to compliance with the North
Carolina Coastal area Management Authority (CAMA) it is necessary to notify
the adjacent riparian property owners of the intention to build, and to receive
from them a statement indicating that they have no objections to construction
of a dwelling. CAMA has issued or will issue an exemption of their requirements
for this property.
Please indicate by -endorsement below on -the original letter if you -have. no.
objections. The copy is for your files.- Your endorsement is necessary in order
that we may proceed to obtain septic and building permits.
Date:
X
M
If you have any questions, please call me collect .[phone].
Thank you for your prompt reply.
Sincerely,
Rita Roberts
We have no objections to the construction of -a
dwelling on Lot 98, Carolina Dunes
--BUILDERS BROKERS SALES - - RENTALS-

REALTY
PHONE [phone]
P.O. BOX 130 • MILEPOST 101h • RT. 158 BY-PASS • NAGS HEAD, N. CAROLINA 27959
February 10, 1984
t
Mr. Wilson N. Phelps, Jr
4717 Larkspur Ct
Virginia Beach, Va. 23462
Dear Mr. Phelps,
Dare County tax records indicate you to be the owner of Lot 97, Carolina
Dunes.
Mr. David Forr is the owner of adjacent Lot 98, Carolina Dunes and is
contracting Nags Head Realty to build a 1020 square foot one story dwelling
with three bedrooms and two baths on his lot.
Since all sound front properties are subject to compliance with the North
Carolina Coastal area Management Authority (CAMA) it is necessary to notify
the adjacetn riparian property owners of the intention to build, and to receive
from them a statement indicating that they -have no objections to construction
of a dwelling. CAMA has issued or will issue an exemption of their requirements .
for this property.
Please indicate by endorsement below on the original letter if you have
no objections. The copy is for -your files. Your endorsement is necessary in
order that we may proceed toobtainseptic and building permits. -
If you have any questions, please call me collect [phone]. -
Thank you for your prompt reply.
Sincerely,
Date•
X
X
BUILDERS •
Rita Roberts .
We have no objections to the construction of a dwelling
on Lot 98, Carolina Dunes
�i
BROKERS -
SALES __ _ RENTALS

OFFICE:
mile ►oat - 10. P. O. bo ■ 7=6
OFFER TO PURCHASE AND CONTRACT Routs 158. by -Pon
Nap+ Hood, North Carolina 27959
Ph: [phone]
David M. Forr and wife Nane� L. lore as Buyer. hemh} agrees
ill purcha%c and ... _Hobert McUa ........... ....... ................ .................................................. ... as Seller.
hrreh% agrees to sell and cnwi e%. all of that plot, piece or parcel of land descrihed below. together with all improvements located thereor,
and such personal propem as is listed below (thereat and personal propen% are col)ecuvek referred to as "the Propem"). inaccordance
with the Standard Provisions on the REVERSE SIDE HEREOF and upon the following terms and conditions:
1. REAL PROPERTY: Located in theC*-e4-..Tc%m .cf..Duck................................................................ . Count% of
Dare .. ... .... ..... . . . .. _ .......... ..................... State of Nonh Carolina. being known as and more pan icularh
described .
Slice: Addrebs ....... ......
... ........... .. . . . ....... .
Lrcati,r.:nn:;c,r ..Lot 98, Carolina._Dunes, Duck, Atlantic .Tot+rnships-Dare Cotmtyb•.••.•
. 1N.C....................................................................................................................................7....
.2. PERSONAL PROPERTY: ......... N/A ....................... .
...............................................................................
. .....................................................••••.................................:...............................................................
3. PURCHASE PRICE: Tr,: purchase price is S ....35,000 (Thirty..Five Thousand..Do,liars).......................
and shall hr paid as follow s
(a'► Sth10OLDD �ivbiaM,#J96,, c fTrTts)'i�Mi'2�Ac;OttW,�rR1A4r1day f e ance of thin Offer .
tt€caltp
a. agent. until the sale is closed. at which time it will he credited to Buyer. or until this agreement is otherwise
terminated as hereir. prrn ided.
(hi 5_ _19.MD. approi: as•umpiion of the unpaid principal haiance and all obligations of Seller or, the existing loan secured b, a
deed of trust on the Property:
b. a pn+rnissorn note secured by a purchase monel, deed of trust on the Propeny with interest pnor to default a:
the rare of _N/A r per annum. pa}able h+ _N/A _ pa%menu of S commencing or
_. __ N/A _ —_ __ . Prepayment rights. if an.. shall tr. ^ __-N/A_ ... ___ _ ._ —_— - - —
(d ) 5.14, 200. _ ,_ _ the haiance of the purchase price in casF, a: closing - — - - - —_
A. CONDITIONS: (Stan N'A ir, each blanl, of paragraph 4 (al and (b) tha; is not a condition to this contracli
(a) The Buyer must he able to obtain a firm commitment for a ........................................................ . . loan in
the principal amount of c ....... N/A ................. for a tern of ........ %ears, at an interest rate not to exceed
........N/A ................ Prior tc. ........ Buser agrees to advise Seller immediately upon his acceptance
of ouch firm, commitment and u+ use- his best efforts to secure such cornmitmen:.
t h) Mon rape loan discount p,-)inr, not to exceee .......N/A...... .. S: of thr loan shall be paid bN...........N/A...................
. and eclat, closing costs shall be paid h, N/A ....................................................... .
i c i Thrrc must tk• no resinctions. easement. Zoning or other go►emnicnial regulation that w ould pre vent the reasonable use of the real
pn+pen% to: ..Re.. ...sidential ... .. .. _............... purposes.
_. OTHER PRMISIONS AND CONDITIONS:
(a, All of the Siancard Pro%.,iorn nn the REVERSE SiDE HEREOF arr understood and slat appi% to this instrument. except the
ioliov in f• numbered Standard Pro%isun, shali he•deleied........ 3-7-.8-9-10-11 .....................................
Ili nano are to be deieted. state • Nont' in this blanl.) b) Buyer is capable of closing and will close at.
anytime C) Seller has 'Thirty Days to accept,_counteroffere -or reject this- of f er, -othervise
it will be withdraw-- by Buyer.
(1' additional space i, nrrdee. th; N-)Ti(JTr, o' the reverse side of this page ma\ he used)
f,. CLOSING: All P;Jnlel agrrP to execuir an•, and all documents znd papers necessar\ in connection w ith closinc and transfer of title
On o: leiore 60 Days After Acceptance of this Offer at a place designated b�
y ........ ...
....Seller..ts Attorne................................ Fred istc,hcmadeto David •H:.•Forr••••••••••••••••••
and..wife..Nancy..A...Forr
................................................................................................................................................
i. POSSESS)O'\: Possessm- sha1: hc-deL.eied .......At -closing ........................................................................
.. .......... I .......... ............. ..... ir: the event that Buyel has agreed
th�:1++,••e��ic,n►>nc�tdeis�erec +�;nc.tr,er.Sclir agreestc�pa•a+Buverthrsumof .. .K/A. ........... ....................... per day
it, anC; rn: iudmt- the date tha, p? ,e-kior. is. to bV del,.ered a�, a►r .c sell iurtt.
E. CM'N7EkI'.ARTS: Tr,:- 0"ie- shal' t-wcomc , hindrrit con:ra:t when si,ned h\ hot!. Eu.r: and Seller and is executed-ir.
4 (Fu r) .<+umrrpan>. ni. a;, exrcutrd cc+unterpan hrtni retained b� each pan. hereto, _. .. ..
Date of Gifu l A
`. r. ! f ...1.�� ...... Date of Acceptance ...../ ....�... ......�.. .........
!i�.`.;//er......... (SEALi f��L��
5 u• e• � �1.7'- SPl er v,•ner + , � e Al.
EAL)
.. r, (CFAI (SEAL
I._S, A..
vacs Rea: Realm !gag: }•icac ReahN
1 h�rrh• a, l.r, +,, irJ_ rr..:! : W the r rnr•; a m it I,: te'f. .c, * t,,,^, ,.. a., n:,:;,r..: Wit: th; tL: ice:• f (o

4-'27054
030, 475-36404
PROPERTY DESCRIPTION: Lot '98, Section-B, -Carolina Dunes
SELLER: Robert -1. McKee and wife, Denise McKee
PURCHASER: David M. Forr and rife, -Nancy-A. Forr
PURCHASE PRICE
DEBITS:
RECORDING FEES
ATTORNEY FEES Aldridge, Seawell 6 Khoury
TITLE INSURANCE Safeco
S nVEY - George Midgette. Jr.
1983 Pro-Rata Share of Dare County Taxes
- 7117."., -1-- -
CREDITS:
$35 000.00
6.50
70-OD
42.21
,;35,543.71
with Atlantic Realty 1,800.00
19,079.82-
-sumpticM_
190.80
Interest credit from seller (IP11/83-to 11/10/E3'.
14-47 AS-_
35,.543.71 Z
J,
TF t T __T1 r �
11P= 01
OUyly;-.- WS
V
t it==?,! t. �t-� `;'. �_i;{ji�11L,��.'�'•��t.=j'.s�l tjl;=1��' ! �1! t 'I !�-t'1
_Z 7--
Z
T 7=�5 —.1 T L 'A0CjQkj IL—_
T
W iT gASTCAR0,),1 183 AII&='I L
IJ I s
t i ''DOfl,:�1l:�=�t��--�%4.����i�=�.5•��:'•:��-�i�!;�-i�,',�ii�p.'.{i`! #.! i—! 1 �-� ! ill' Ej 1, -aill a I
.12 Its*•Ali =All.-

a.�
or ro ina epar men o a ura
Resources &Community Development
James B. Hunt, Jr., Governor Joseph W. Grimsley, Secretary
Field Services
108 S. Water Street
Elizabeth City, N. C. 27909
February 9, 1984
Mr. Stewart A. Crank
Construction Department
Nags Head Realty
P. 0. Box 130
Nags Head, North Carolina 27959 -
Subject: a. David M. and Nancy CII.IlFoar!P�)posedResidential Development
at Lot 98, Sectioniina Dunes, in Duck, Dare County
b. S. Chris and Noelle G. Payne Proposed Residential Development
at Lot 177, Section "G" Colington Harbour Subdivision in
Dare County
Dear Mr. Crank:
On January 31, 1984, this office received plats of the above -mentioned
proposed residential developments in Dare County. This office has reviewed
these projects for CAMA Mi'nor`Development Permit requirements.
Based on this review, tt has been determined that these projects should
be most properly handled with a CAMA Minor Development Permit application.
You should complete the enclosed application form and submit it to this
office with the following materials:
1. A plat showing all of the proposed structures, includ-
ing septic tank location.
2. A copy of the deed or offer to purchase of the subject ,
property..
3. Copies of letters mailed to the adjacent reparian property
owners notifying them of the proposed project.
.4. A check written to the Department of Natural Resources
and Community Development (DNRCD) to cover the costs of
the required public notice.
P. 0. Box 27687 Raleigh, N. C. 27611.7687
An Equal Opportunity Affirmative Action Employer

4W flo
P.O. BOX 130 • MILEPOST 101/2
Coastal Resources Commission
108 S. Water Street
Elizabeth City, N.C. 27909
Dear Sir,
H&A
REALTY
PHONE [phone]
• RT. 158 BY-PASS •
January 30, 1984
NAGS HEAD, N. CAROLINA 27959
Please find enclosed a copy of a plat located soundfront in Carolina Dunes
Subdivision of Duck (moreproperlyLot 98, Section "B" Carolina Dunes)
The property owners, David M. Forr and Nancy:.A. Forr, would like to request
a variance from the 75' foot setback requirement and set it as close to the front
40 foot of the property as the property and your office will allow.
We have already engaged the services of George W. Midgette, Jr, a registered
North Carolina Surveyor, to permanently locate the front 40' set back line.
I appreciate your time and attention to this matter. Please inform me as.soon
as possible of your decision and/or any other requirements you may have.
Very truly yours,
Stewart A. Crank
Construction Department
enc.
dw/SC
BUILDERS- -_ - BROKERS__- - -- SALES.. f�ENTALS_ --

f APPROX. N[iN • '' ' Z� !LS.. .�
�. WATER LINE
H vf.
PIN SET-... t'28'00�
75. ....OLD PIN
•Tie Lin
3a•_
J.E�
.i 11
99 98 9T
* E GROUND EV. +IE BLDG. S • r`
6. MEAN L
N
(lEJ65 SO I )
(0.431 ACR )
i
C J D t
in
cy
3 �
.p z
000 8
on
q� _
(M.B.G. PG.39)
.: R,hr C.M -...VEPCO TNANSFORMER
se.a• i
OLO PIN 76D — 75.DD' 70D OID PIN
-PIN SET S01028'00"E :....am
PIN
N. C. S. R. (Ed1RW) # 1200
LOT SURVEY
FOR: DAVID M. 1S NANCY A. FORR
OF: LOT 98, SECTION "B"
CAROLINA DUNES
` ATLANTIC TOWNSHIP, DARE COUNTY, NORTH CAROLINA
I, George W. Midgetie, Jr.,RI.S., ar1My that this piaf was drawn from an actual field land survey;
that the error of closure as calculated by lalltudes and departures is I-IOpOO; shot It was prepared
in accordance with G.S.4T-30 as amended.
Witness my hand and saol this tl th. of OCTOBER ' , A.D. *83 . Jr Grtitbat 278rr'
GEORGE W MIDGETTE, JR., LAND SURVEYOR
NORTH CAROLINA AND VIRGINIA
K 90X 406/KWTY HAWK, N.C. 27949
TELEPHONE [phone]
STD w•.
.p�9
:AL
I_-F'ERENCE : ( M.6 6 PG. 59) FIELD GATE: OCTOBER K),1983
FILE NUMBER: 298-83-4-66 SCALE I"- 30'

STATEMENT OF OWNERSHIP
r
A
a
I, the undersigned, an applicant for a CAMA minor development permit, being either the owner of property in Z
an area of environmental concern or a person authorized to act as an agent for purposes of applying for a CAMA ,y
minor development permit, certify that the person listed as landowner on this application has a significant interest
in the real property described therein. This interest can be described as follows: (check one)
Xan owner of record title, Title is vested in l . '�
see Deed Book 3�5� , page in the
c� County Registry of Deeds. 1'•�
Z,.
an owner by virtue of inheritance. Applicant is an heir to the estate of
probate was in County. p
if other interest, such as written contract or lease, explain below or use a separate sheet
attached to this application.
r
0
A
NOTIFICATION OF ADJACENT PROPERTY OWNERS a
r
1 furthermore certify that the following persons are owners of properties adjoining this property. 1 affirm that {
I have given ACTUAL NOTICE to each of them concerning my intent to develop this property and to apply for u
a CAMA permit. D
(Name) (Address)
(') „�°Y.. ,p ��Ds T,�1& � ,C�-►-,� s.�}icy (.� 1JQ t�cf 1>�.
(2) _ o A 11.11e .9J
(3)
(4)
FOR DEVELOPERS IN OCEAN HAZARD AND ESTUARINE SHORELINE EROSION AREAS:
I 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
particular hazard problems associated with this lot. This explanation was accompanied by recommendations
concerning stabilization and flood -proofing techniques.
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.
This the day of
Land owner or person authorized to act as his agent
for purposes of filing a CAMA application.

SITE DRAWING /APPLICATION CHECKLIST
Please make sure your site drawing includes the following information required for a CAMA
minor development permit. The drawing may be simple and not necessarily to scale. The Local
Permit Officer will help you, if requested.
PHYSICAL DIMENSIONS
label roads
label highway right of ways
label local setback lines
label any and all structures and driveways currently existing on property
PHYSICAL CHARACTERISTICS
draw and label mean high water mark (MHW)
draw location of septic tank or filter field
If you will be working in an ocean hazard area:
draw and label dune ridges (note height)
draw and label toe of dune
identify and locate first line of stable vegetation
draw and label setback line under CAMA
draw and label topographical features (optional)
If you will be working in an estuarine shoreline area:
draw and label landward limit of AEC
describe terrain (slope)
DEVELOPMENT PLANS
draw and label areas that will be disturbed
if house to be placed on lot, describe location of house
note size of piling and depth to be placed in ground
draw and label all areas to be paved or graveled
describe composition of surface
note and list fully all trees and vegetation to be removed or relocated
show landscaping
NOTE TO APPLICANT
Have you:
• completed all blanks and/or indicated if not applicable?
• notified and listed adjacent property owners?
• included your site drawing?
• signed both application and statement of ownership?
• enclosed the $25.00 fee?
• completed an AEC Hazard Notice,if necessary?
FOR STAFF USE
SITE NOTICE POSTED FINAL INSPECTION
SITE INSPECTIONS
i�
if
s DATE OF ACTION:
ISSUED
FEE RECEIVED
EXEMPTED DENIED APPEAL DEADLINE (20 days)