Not Given_Moore, John T. & Ruth J._19840913 (3)

LRAL INFORMATION
1. LAND OWNER
Name
P
Address
r
RECEfVE
_ .0� /Igl BEP13'84
City State VA 23434
Zip Phone [phone]
2. AUTHORIZED AGENT
Name -
Address
Phone
Jwr �►
3. LOCATION/DESCRIPTION OF PROJECT anti=Vt A Albatross SErw_t-
,� r-
4. AREAS OF ENVIRONMENTAL CONCERN (AEC) CLASSIFICATION
(To be filled in by Local Permit Officer prior to completing application.)
r X Ocean Hazard Estuarine Shoreline - Other
City State
iP
o
5. PROPOSED USE
---_ Residential Commerical/Industrial Other toA dune
6. SIZE OF BUILDING IN SQUARE FEET: NSA -
7. SIZE OF SITE IN SQUARE FEET:
This application includes: general information (this This, .Te 1_ 4th day of August
foim), a site drawing as described on the back of this 19 -
application, the ownership statement, the AEC. hazard
• notice where necessary, a check for $25.00 made payable /�r"^''�
to the locality, and any information as may be pro- 444 , _ I/l •
vidcd orally by the applicant. The details of the applica- A�hcant's signature (or authorized agent)
tion as described by these sources are incorporated
without fcfcrcnce�In any Permit which may be issued. Indicate below address and phone if not shown above.
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
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).. .
...heating and air conditioning...insulation and energy
burning...electrical...plumbing
conservation ... FIA certification ... sand dune ... sediment control ... subdivision approval
...mobile home park approval ... highway connection ... others: