84-0023_Roper, Sr., Leroy B. & Mary Clair C._19840308 (3)

APPLICATION
FOR
­
—Y CAMA
-MIN R
PERM
D ' VELOP�tENT
�a k IT
In 1974 the North► Carolina Generasserx�.
,
bl passed the Coastal Area M. nagerrtg# ct��
Y
' and set the'stage %r guidmgidYloppmen n `
the fragile and productive areaswjiiCh bore a,
he state's estuanes, soundsn oceanfront'
<.,
;Along withffirequ nngMspc�at dare by those*' d
fvho build and,deve�op, the General Assembl
Mai* vt
directed the Coastal"Resources (;Qmmissli5n to
jmple ent.clea� regulations hich minimize
aethe!burden on tlie applicant..
fir`
"his applicationifor a minon�deqlopMgrit per- `
.y it it under CAMA is part of)the,CQ6r ils's,i"SO's '
effort to eet the spirit andjntent of -the + 41
s � � m er t
_t m General Assembly. It has been designed to 6e s
straightforWar'd an&r�quire no more.time or .
i `"�" effort than,nece sary froni.the applicant. f
Pleasef go Oyer';,t is folder with the Loyal
Permit Officer for the locality in which,you l
plan to buildio a certaa tha�yo'u,under-
stand what information hshe.rreeds.
. Under CAMA rggua ions the minor permit
. is to be issued within � days once a complete
1 '' :
p Icattonjs in hand. 0 en less time is needed
}it the project is sir p e The process generally
ltakes,about 18 days l ou can help speed the
�E� I
approval process by raking certain that your
application is comple �and signed, that your
1� - arawing'meets the sp
� and�that�y`ourapecifications given inside
I cation fee is attached.
,Other permits aces metimes required for
develo ment in ti c astal area. While these '
L =� e got CAM A=related-we urge You to check k
with the LocalPeFmit Officer`todetermine.. F
z&
rvhicof these you may'need A listmg4is
included on par, em o er.
'We appreciate your cooperation with the
North Carolina coastal management program .
and your willingness to build in a way which
protects the resources of our beautiful and
- productive coast.
'Coastal Resources Commission
Office of Coastal Management - -
f
IF

GENERAL INFORMATION
1. LANDOWNER
Name le -A. Ry e-rle SR. 8 %VAete GzC R 0
Address % O G 6t/i_s To ger�f
City Pe 4tx-s©r State Via Zip 33 8 a S Phone [phone]
2. AUTHORIZED AGENT
Name _ /Ut 4L /0- A34&Nec
Address A60 X
City -A AS d/ki State 1rA • Zip �13 90 44 Phone $ D 4 '73 a. a %53
3. LOCATION/DESCRIPTION OF PROJECT __Zee- -C* A TL+fNTi C 7.1W S4 v
Dfl2E' f;a crvey "y r.
4. AREAS OF ENVIRONMENTAL CONCERN (AEC) CLASSIFICATION
(To be filled in by Local Permit Officer prior to completing application.)
Ocean Hazard
5. PROPOSED USE
V Residential
Estuarine Shoreline Other
Commerical/Industrial Other
6. SIZE OF BUILDING IN SQUARE FEET: 2 048 Li vi.v52 Zo 3 Pe-eAr-s
7. SIZE OF SITE IN SQUARE FEET:.. ''L 2 . Z Z?
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 2'51 day of FeASsUrA"
19,1A.
_% A-Q)A aAAU,-->
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 ... 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:

NEAL A. BARNES CONSTRUCTION CO.
yes o�
P. O. BOX 1267 t E1-•- h :,►
732-2593
PETERSBURG, VIRGINIA 23803�r
i
Dear Mr. Wood:
Enclosed is a copy of the letter sent to Dr. Stallings concerning
the LAMA Permit for LeRoy Ro s house in Sanderling.
Neal A. Barnes

°Ss°sus�.r"0v
'warts s
NEA! A. BARNES CONSTRUCTION CO.
P.O. BOX 1267
732-2393
PETERSBURG, VIRGINIA 23803 ,
February 20, 1984
PE ,r; ,�:
ACT 17 184
- OG'Pri - EC
Dr. James A. Stallings / 1 .� q� 74�, -7
7804 Ivymount Terrace Z'
Potomac, Maryland, 20854
Dear Dr. Stallingss
We have applied for a CAMA perms) to build a cottage on Lot 53,
Sanderling SID, Atlantic Township, Dare County, North Carolina, which
is next door to you. The house is to be built in accordance with the
standards of.Sanderling. We are building the cottage for Mr. LeRoy Roper
of Petersburg, Virginia. Mr. Roper is President of Roper Bros! -Lumber Co.
and also Mayor of Petersburg.
Sincerely,
Id
Neal A. Barnes
4

Dare County/(DNRCD)
Local Government
84-0023
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 Leroy B. Roper, Sr. and Mary Clair C. Roper
authorizing development in Janaerling JUDglylslon at Lot 53
as requested in the permittee's application dated February 23, 1984
This permit, issued on March 8, 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.
1. All development will be in accordance with attached application
and plats.
2. Prior to undertaking any development authorized by this permit,
the applicant, or the authorized agent, is required to sign the
enclosed AEC Hazard Notice and return it to this office.
This permit action may be 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 September 8, hIkVs permit expires on
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.
P
Nelson G. Paul Locr
Officer (signature)
Office of Coastal Management
108 South water Street --- name
Elizabeth City, N. C. 27909
[phone]
address
Permitee (signature required if special conditions above apply to permit)

NORTH CAROLINA DEPARTMENT OF
NATURAL RESOURCES AND
COMMUNITY DEVELOPMENT
NELSON G. PAUL
FIELD CONSULTANT
.. OFFICE OF COASTAL MANAGEMENT
108 SOUTH WATER STREET
ELIZABETH CITY, NC 27909 [phone]

AEC HAZARD NOTICE
YOUR PRO) EC7{ IS IN AN:
-$--OCEAN ERODIBLE AREA
HIGH HAZARD FLOOD AREA
This notice is intended to make you, the appli-
cant, aware of the special risks and conditions
associated with development in this area, which is
subject to natural hazards such as storms, erosion
or currents. The rules of the Coastal Resources
Commission require that you receive an AEC
hazard notice and acknowledge that notice in
writing before any permit for development in this
area can be issued.
i2� FI 12 0
moo.
C EC
INLET HA-Z-AB AREA
the annual ocean erosion rate for the area where
your property is located is 6 feet per year.
This figure was established by careful analysis of
aerial photographs of the coastline taken over the
past 30 to 40 years.
Studies also indicate that the shoreline could
move as much as 4'1�_ feet landward in a major
storm.
The Commission's rules on building standards, The flood waters in a major storm are predicted
oceanfront setbacks and dune alteration are to be about feet deep in this area.
designed to minimize, but not totally eliminate,
property losses from the hazards. By granting Shoreline erosion control structures (excluding
permits, the Coastal Resources Commission does beach nourishment and berm projects) are not
not guarantee the safety of the development and allowed to be built to protect development built
assumes no liability for future damage to the after June 1, 1979. Limited pushing up of beach
development. sand is allowed to protect new structures when
they are threatened, but bulkheads, groins, or
The best available information, as accepted by jetties may not be used to protect buildings put in
the Coastal Resources Commission,_ indicates that ,a r-iane-l; 197g
If 94
Date Applicant's Signature
The applicant must acknowledge receipt of this information by signing this notice in the space above. Without
the proper signature, the application will not be complete.
SPECIALNOTE: This hazard notice is required for development in areas subject to sudden and massive storms and
erosion. Permits issued in this area expire in six (6) months. To continue your work past that date you must contact
the local permit officer before the expiration date for a six-month permit extension. This is granted if there is no -
change in the project site or if you have made "substantial' progress" on your project. Normally a permit can be
extended five (5) times for a total project life of three (3) years. If the site has changed and you have not made progress,'
the LPO will determine the new vegetation line and apply the earlier setback distance to show you the new setback for
your project. IT IS'IMPORTANT TO UNDERSTAND THAT YOU MUST RECEIVE OFFICIAL APPROVAL TO:
CONTINUE YOUR ;WORK 'AFTER THE EXPIRATION DATE ON YOUR PERMIT. IT IS UNLAWFUL TO
CONTINUE WITHOUT THIS APPROVAL.
FOR MORE INFORMATION, CONTACT:
LOCAL PERMIT OFFICER:
ADDRESS:
LOCALITY:
PHONE: S
SC/ Rev. 6183

BEFORE YOU BUILD ...
Setting Back for Safety: A Guide to Wise Development Along the Oceanfront
When you build along the oceanfront you take a calcu-
lated risk. Natural forces of water and wind collide with tons
of force, even on calm days.
There are no man-made structures guaranteed to survive
the force of a hurricane. Long-term erosion (or barrier
island migration) takes from two to ten feet of the beach
each year and, sooner or later, will threaten oceanfront
structures.
These are the facts of life for oceanfront property owners.
THE RULES
When you build along the oceanfront, coastal manage-
ment rules require that the structure be sited to fit safely
into the beach environment. Specifically, a structure along
the oceanfront must be: (1) behind the frontal dune; and,
(2) landward of the crest of the primary dune; and (3) set
back from the first line of stable vegetation a distance equal
to 30 times the annual erosion rate or 60 feet, whichever is
greater.
The Coastal Resources Commission has adopted rules
for building along the oceanfront. The rules are intended to
avoid an unreasonable risk to life and property and to limit
public and private losses from both storms and long-term
erosion. These rules do not eliminate —but only lessen —the
element of risk in oceanfront development.
As you consider building along the oceanfront, the CRC
wants you to understand the rules and the risks. With this
knowledge you can make a more informed decision about
where and how to build in the coastal area.
THE REASONS
The beachfront is an ever -changing landform. The beach
and the dunes are nature's "shock absorbers", taking the
beatings of the wind and waves and protecting the inland
areas. By setting back 30 times the annual long-term erosion
rate, you have a good chance of enjoying the full life of the
PERMITTED" -
STRUCTURE;
ADEQUATE
SETBACK
I SETBACK I FIRST LINE OF
I� STABLE NATURAL
30xANNUAL VEGETATION
AVERAGE
EROSION
RATE
A4
structure. At first glance, it seems very inviting to build
your dream house as close to the beach as possible but in
five years you could find the dream has become a night-
mare as high tides and storms threaten your investment.
PRE -PERMIT STRUCTURE; INADEQUATE SETBACK
PRE -STORM BEACH PROFILE
POST -STORM BEACH PROFILE
�,���STORM/B EACH REBUILDING
After the storm, the house on the dune wIII be gone. The other has a much greater chance of survival.
THE EXCEPTION
The Coastal Resources Commission recognized thatthese
rules, passed in June of 1979, might prove a hardship for a
small group of property owners. So there was an exemption
established for lots which cannot meet the setback require-
ments of 30 times the annual erosion rate. The exemption
allows building in front of the setback line under certain
conditions. These are:
(1) the lot must have been platted as of June 1, 1979,
and not capable of being enlarged by combining
with adjoining land under the same ownership; and
(2) development be as far back on the property as possible
and in no case less than 60 feet landward of the
vegetation line; and,
(3) no development can take place on the frontal dune;
and,
(4) special construction standards on piling depth and
square footage must be followed; and,
(5) all other CAMA, State and local regulations must also
be met.
The exemption is not available in the Inlet Hazard Areafs
which are especially dynamic.
In seeking this exemption the Local Permit Officer will make these measurements and observations:
required setback from vegetation line max. allowable square footage on lowest floor
exception setback (maximum feasible) lot area as calculated from vegetation line
rear property line setback piling length necessary to extend 4 feet below MSL

f
North Carolina Department Natural
OFFICE OF
ten} ` of
COAUAL MANAGEMENT
Resources &Community Development
David W.owens
Director
James B. Hunt, Jr., Governor James A. Summers, Secretary
Telephone [phone]
Field Services
108 South Water Street
Elizabeth City, N. C. 27909
[phone]
February 24., 1984
The Coastland Times
P. 0. Box 428
Manteo, North Carolina 27954
Gentlemen:
Please include the enclosed Notice(s) of Filing in. the Public
Notice section of the Thurs., March 1,1984 edition of your newspaper.
If it will not be possible to include these notices in that edition, or
if you should have any questions about these notices, please call me as
soon as possible at 338-1558.
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 Cathey Cottle, Office of Coastal Management, Department of Natural
Resources and Community Development, P. 0. Box 27687, Raleigh, N. C.
27611-7687.
Thank you.
Cordially yours,
Nelson G. Paul
Field Consultant
Enclosures: Roper t-
rjgg
P. O. Box 27687_ Raleigh, N. C. 27611-7687 "
-- An Equa/Opportunit Affirmative ActionEm to er

NOTICE OF FILING
OF APPLICATION FOR
CAMA MINOR
DEVELOPMENT PERMIT
Pursuant to NCGS 113A-119(b), the North Carolina Department of
Natural Resources and Community Development Office of Coastal Management,
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 23 1984 , the
applicant, Leroy & Mary Roper proposed to construct
an oceanfront residential structure
at Lot 53. Sanderlinp Subdivision. north of Duck in 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
Office of Coastal Management
108 South Water Street
Elizabeth City, N. C. 27909
[phone]

NEAL A. BARNES CONSTRUCTION CO.
4 P. O. BOX 1267
732-2593
PETERSBURG, VIRGINIA 23803
Februar 20, 1984
Mr. Malcom G. Slaney
1675 Glourseter Court
Sewickley, Pa.,15143
Dear Mr. Slaney I ',
We have applied for a CAMA permit to —build a cottage on Lot.53r
Sanderling SIDI,'Atlantic Township,--Dfre County, North Carolina, which
is next door to you. The house will be built in accordance with the
standards of Sanderling. We are building the cottage for Mr. LeRoy
Roper of Petersburg, Va. Mr. Roper is president of Roper Bros Lumber
Co and is.also the Mayor of Petersburg.
Sincerely
7
Neal A. Barnes

NEAL A. BARNES CONSTRUCTION CO.
P.O. BOX 1267
732-2593
P€TERSBURG, VIRGINIA 23803
Februar 20, 1984
Mr. Malcom G. Slaney
1675 Glourseter Court
Sewickley, Pa. • 15143
Dear Mr. Slaney:
We have applied for a CAMA permit to build a cottage on Lot 53►
Sanderling SIDI, Atlantic Township, Dtie County, North Carolina, which
is next door to you. The house will be built in accordance with the
standards of Sanderling. We are building the cottage for Mr. LeRoy
Roper.of Petersburg, Va. Mr. Roper is president of Roper Bros Lumber
Co and is also the Mayor of Petersburg.
Sincerely
r V��/
Neal A. Barnes
y

NEAL A. BARNES CONST. CO. DETACH AND RETAIN THIS STATEMENT
THE ATTACHED CHECK IS IN PAYMENT OF ITEMS DESCRIBED BELOW.
IF NOT CORRECT PLEASE NOTIFY US PROMPTLY. NO RECEIPT DESIRED. _
DELUXE - FORM NWC-2 V-2
DATE _ DESCRIPTION AMOUNT -
V-S

NEAL A. BARNES CONSTRUCTION CO.
s
P. O. BOX 1267
RFOSl E 732-2593
PETERSBURG, VIRGINIA 23803
MAR 07'84
QC;,l - EC

DARE PROFESSIONAL CENTER
CORNER OF U. S. 64 AND FERNANDO STRErf
[phone]
DWIGHT H. WHELESS
ATTORNEY AT LAW
January 30, 1984 POST OFFICE BOX 500
MANTEO, NORTH CAROLINA 27954
Mr. and Mrs. LeRoy B. Roper, Sr.
P. 0. Box 630
Petersburg, Virginia 23804
Dear Mr. and Mrs. Roper:
I am pleased to enclose your original recorded deed of conveyance
from Remington of Lot 53, Sanderling Phase 2, which now appears of
record in Deed Book 359 at page 433, Dare County Registry.
Also enclosed is your final policy of title insurance issued by
Lawyers title Insurance Corporation of Raleigh, North Carolina,
and being policy #101-81-065642.
Very truly yours,
Dwight H. Wheless
DHW:g
Enclosures

J r �`'�►�#AT E OF •"•, Real Estate
OR' , '� Excise Tax
mot' v V JAN 20'84 �.::..•+ 6 J. Q 0
c P.B.10717 '
Excise Tax $85.00
Book 359 PWCE 433
FILED
'84 JAN 20 PH 12 03
ALVA 0. VIISE
REGISTER OF DEEDS
DARE COUNTY. N.C.
Recording Time, Book and Page
TaxLot No. ............................................. ............................................. Parcel Identifier No...........................................................................
Verified by.............................................................. . County on the day of ..., 19............
by..................... :................................................................................................................................................................... I......................................
Mail after recording to IhaiBht H. Wheless, Attorney at Law, P. 0.'Box 500, Manteo, NC 27954
.. ............... .... .............................
....................................................................................................................................................................................................................................
This instrument was prepared by Dwight ... li.....Whe1_es.s.,...Attorney... at...Lay..,..P.....0.....Box..5.00.,...Man.teo.,..NC... 27.95.4...
Brief description for the Index Lot 53, Sanderling Phase 2
NORTH CAROLINA GENERAL WARRANTY DEED
THIS DEED made this .... i6th„ day of ..........December .............................. .. . 19..U...... by and between
..
GRANTOR 1 GRANTEE
JAMES A. REMINGTON and wife,
JEAN M. REMINGTON
58 Trails End Road
Weston, CT 06883
LE ROY B. ROPER, SR. and wife,
MARY CLAIR C. ROPER
an estate by the entireties
P.' 0. Box 630 - -
Petersburg, VA 23804
Enter in appropriate block for each party: name, address, and, If appropriate, character of entity, e.q. corporation or partnership.
The designation Grantor and Grantee as used herein shall include said parties, their heirs, successors, and assigns, and
shall include singular, plural, masculine, feminine or neuter as required by context.
WITNESSETH, that the Grantor, for a valuable consideration paid by the Grantee, the receipt of which is hereby
acknowledged, has and by these presents does grant, . bargain, sell and convey unto the Grantee in fee simple, all that
certain lot or parcel of land situated in the City of ........................................................ I ... I .......... Atlant:ic.................. Township,
....Dare ...................................... County, North Carolina and more particularly described as follows:
Being known and designated as Lot 53 as shown on a plat of Sanderling, Phase 2,
recorded in Plat Cabinet A at slides 90 and 91 in the Office of the Register of
Deeds of Dare County, North Carolina, to which plat reference is hereby made for
a more particular description.
N.C. Bar Assoc. Form No. 3 s7 1976. Revised 1977.
•
���. ni w vrcemvm wi,A 1`.e N.C. Per M x-1981.

eoox 358 i-4t 434
The property hereinabove described was acquired by Grantor by instrument recorded in..............................................................
.......Deed Bo_ok... 287 at..P.age .305.�... Dare... County...Regi.S ry... ........................................................................................................
A map showing the above described property is recorded in Platt CaUnet..A..............4mgs..S1!de.s...90- and 91.
TO HAVE AND TO HOLD the aforesaid lot or parcel of land and all privileges and appurtenances thereto belonging to
the Grantee in fee simple.
And the Grantor covenants with the Grantee, that Grantor is seized of the premises in fee simple, has the right to convey
the same in fee simple, that title is marketable and free and clear of all encumbrances, and that Grantor will warrant and
defend the title against the lawful claims of all persons whomsoever except for the exceptions hereinafter stated.
Title to the property hereinabove described is subject to the following exceptions:
such easements as may appear of record in the Dare County Registry, and those certain
protective covenants recorded in Deed Books 248 at page 661, 253 at page 281, 264 at
page 661, and 266 at page 90, Dare County Registry.
IN WITNESS WHEREOF, the Grantor has hereunto set his hand and seal, or if corporate, has caused this instrument to be signed in its
corporate name by its duly authorized officers and Its seal to be hereunto affixed by authority of i;,Ho d of Directors, the day and year first
above written.
--------------- =----------------------------------------------- - - -- -- -- -- ---- - ----- -- - --'---(SEAL)
(Corporate Name) ►+
O
Z--------------------------------- - ------------------(SEAL)
---------------------------- President ►.
ATTEST: U
t-------------------------------------------------------------(SEAL)
r�
____________________________Secretary (Corporate Seal) X
-------------------------------------------------------------- (SEAL)
A'Lr� State of:
SEAL4.,....:.1.fkT+ ,� .-KxJ[iti� -------�=3 -r�i�----lfi—County.
i3�0 �; `�nx=.I�'•z Notary Public of the County and State aforesaid, certify that ---- JA'IES A. _9MJXixTQN_-an d____-
>7�. h*r d r_,, _ t� =� _ wife �_ JEAN M. _ REMINGTON------------------------------------------------------------- Grantor,
rg
"retrz'err? ')'personally appeared before me this day and acknowledged the execution of the foregoing Instrument. ess my
a :hnd and official stamp or seal, this _(✓ day of✓ _-________ ----- 9-
,,.•,�,/ y4..ILA—
....� (,�\i .�•• : - �i� .��a� -------- ------- -----4Z& .7.
;,,� ;,,,'AIy commission expires: ___________ ___ ___ _ i_ N fury P bit-- tYf. FStE�t-
� / b
NORTH CAROLINA- _________________ r 31
SEAL -STAMP -----------------County Oualtfled In New York Count47—
%c I, a Notary Public of the County and State aforesaid, certify that COmmisa---lon F�Iras Meld? 30, i_
-------------------- personally came before me this day and acknowledged that ____ he is ___________________________ Secretary of
e
x,______________________________________________________ a North Carolina corporation, and that by authority duly
u
given and as the act of the corporation, the foregoing instrument was signed 1n its name by its _______________
p
u President, sealed with its corporate seal and attested by ----------- as its ___________________________ Secretary.
N
Witness my band and official stamp or seal, this _______day of --------------------------- 19_-_____-.
My commission expires: ------------------------------- ------------ --_----- Notary Public
The foregoing Certificates) of ____________________
--------------------------------------------------------------------------------=-------------------------------------------------------------
----------------------------------------------------------------------------------------------------------------------------------------------
IS
/are certified to be correct. This instrument and this certificate are duly registered at the date and time and in the Book and Page shown on the
first page hereof.
fs�__ _:___.11_ T ��_____---------- REGISTER OF DEEDS FOR ......... DO— �- __________ ___-_COUNTY
By _____________ -- ---- i. _____________Deputy/Aszist-out Register of Deeds
N.C. Bar Assoc. Form No. 3 © 1976, Revised 1977. - RECORDED"OJL-� POOLE PRINTING CO, ING P.O. BOX 17375 RALEIGH. N.C.27619
Printed by Apeement with the N.C. Bar A, 1981. ��— ���/// '

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STATEMENT OF OWNERSHIP
r
i7
' D
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
minor development permit, certify that the person listed as landowner on this application has a significant interest I1
in the real property described therein. This interest can be described as follows: (check one) 1
an owner of record title, Title is vested in Cc 0
see Deed Book, page '-3 3 in the <
County Registry of Deeds. (�
an owner by virtue of inheritance. Applicant is an heir to the estate of
probate was in County.
fl
if other interest, such as written contract or lease, explain below or use a separate sheet
attached to this application.
r
O
n
NOTIFICATION OF ADJACENT PROPERTY OWNERS D
r
1 furthermore certify that the following persons are owners of properties adjoining this property. I affirm that {
I have given ACTUAL NOTICE to each of them concerning my intent to develop this property and to apply for
a CAMA permit.
(Name) (Address) _
I
(1) Ae. JA►nos Q. ST.4A.ua41 7804 /eywovwr 7e"&"rl. PeTernRc %7a1. 30Q.fSi
(2) Mt. knAL. co,n IS. SZ4AJey /to 75 6'.CoyRes?eit. LSdar recyiu'c: �, /,r/ 93
(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 the23 dayof_Pef&iZV*" ,19,b4.
d_W CL41_L4__)
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
A 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:
o 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?
SITE NOTICE POSTED
SITE INSPECTIONS
DATE OF ACTION:
s
ISSUED
FOR STAFF USE
FINAL INSPECTION FEE RECEIVED
EXEMPTED DENIED APPEAL DEADLINE (20 days)