100-88_Onslow County- City of Jacksonville/ Hillebrand, George_19880513

GENERAL INFORMATION
1. LAND OWNER
Name
Address , /
City-✓RG'C�-��it�Y�.�� State N C Zip Phone
2. AUTHORIZED GE/N�41�0
�/ / 21
Name -aC`C! &: ,G ����-ei�7G����
Address
go
1
4 IY;�/
City _A� _ a '1lle State Al, Zip ZZE-6if- % Phor Z1� -r•� '" ad
3. LOCATION/DESCRIPTION OF PROJECT .mot ?(Z 17ca-) 24 42
4.
�rJ1� Sfrce� bei>i1� the Nru>
c�, 7;41_A1 L14A) Tr
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 ////C% irI40.9/
6. SIZE OF BUILDING IN SQUARE FEET: /'Z/
7. SIZE OF SITE IN SQUARE FEET: "`� X /
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...
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 sugges-
tion to help you complete your project as quickly as
possible.
This the 2ofh day ofpI
19
Ap licant's si nature (or authorized agent)
Indicate below address and phone if not shown above.
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:
IT NUMBER j�/V 00 ��✓�

NCDNRCD/DCM 100-88
Local Government Permit Number
MAY i 8 1988 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 ONSLOW COUNTY - CITY OF JACKSONVILLE/MR. GEORGE HILLEBRAND, ENG. SPEC.
authorizing development in the Estuarine Shoreline AEC at Ann St., on the New River
as requested in the permittee's application dated April , 1988
This permit, issued on _Mgy 1 3, 1 988 , 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. Construction of the proposed 24 inch drainage pipe and catch basin must
be accomplished in accordance with the permitted workplat drawing dated
April 21, 1988 RECEIVED.
2. During construction, adequate measures must be employed to control
erosion so as to prevent sediment runoff from entering the adjacent
waters and wetlands of New River.
3. Any changes in the project design or construction will require a
modification of this permit.
4. All construction must comply with all local, state and federal
building code requirements.
5. A copy of this permit must be maintained at the site during constructio .
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 must cease when this 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 Division of Coastal Management,
Local Permit Officer (sign4ure)
James L. Mercer, Field Representative
name
DIVISION OF COASTAL MANAGEMENT
P. O. Box 769
address
Mor
ad
City NC
57
Permit
sigpatur
required if speci
ditions above apply to permit)

SIATI
State of North Carolina
Department of Natural Resources and Community Development
Division of Coastal Management p
512 North Salisbury Street • Raleigh, North Carolina 27611
James G. Martin, Governor
S. Thomas Rhodes, Secretary David W. Owens
Director
Division of Coastal Management
P. O. Box 769
Morehead City, NC 28557
[phone]
May 13, 1988
Mr. George Hillebrand
Engineering Specialist
CITY OF JACKSONVILLE
P. O. Box 128
Jacksonville, NC 28540
Dear Mr. Hillebrand:
Attached is CAMA Minor Development Permit #100-88. In order
to validate this permit, please sign as indicated Retain the
white copy for your files and return the original signed copy to
us in the enclosed, self-addressed envelope.
Your early attention to this matter would be appreciated.
Sincerely,
James L. Mercer
Field Representative
JLM/dh
Enclosures
cc: Charles S. Jones
P.O. Box 27687, Raleigh, North Carolina 27611-7687 Telephone [phone]
An Equal Opportunity Affirmative Action Employer

NCDNRCD/DCM
Local Government
rennrr VWHIUCr
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 ONSLOW COUNTY — CITY OF JACKSONVILLE /MR.. GEORGE HILLEBRAND, ENG. SPEC.
authorizing development in the Estuarine Shoreline AEC at Ann St., on the New River
as requested in the permittee's application dated April 22, 1988
This permit, issued on May 1 3, 1988 , 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. Construction of the proposed 24 inch drainage pipe and catch basin must
be accomplished in accordance with the permitted workplat drawing dated
April 21, 1988 RECEIVED.
2. During construction,.adequate measures must be employed to control
erosion so as to prevent sediment runoff from entering the adjacent
waters and wetlands of New River.
3. Any changes in the project design or construction will require a
modification of this permit.
4. All construction must comply with all local, state and federal
building code requirements.
5. A copy of this permit must be maintained at the site during constructio
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 must cease when this permit expires on
T)PCPmher 11, 1991
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 Division of Coastal lv1anagement.
Z2�Qm . IN -
Local Permit Officer (si nature)
James L. Mercer, Field Representative
name
DIVISION OF COASTAL MANAGEMENT
P. 0. Box 769
address
Morehead Citv, NC 28557
Permittee (signature required if special conditions above apply to permit)

State of North ; Carolina
Department of Natural Resources and Community Development
Division of Coastal Management
512 North Salisbury Street • Raleigh, North Carolina 27611
James G. Martin, Governor David W. Owens
S. Thomas Rhodes, Secretary Division of Coastal Management Director
P. O. Box 769
Morehead City, NC 28557
[phone]
April 29,,,1988
Daily News
Legal Advertisement Section
P. O. Drawer 196
Jacksonville, NC 2.8541
Re: Public Notice - City of Jacksonville, CAMA
Minor Development Permit
Dear Sir:
Please publish the attached Notice in the Tuesday, May 3,
1988, issue of the Daily News.
The State Office of Budget and Management requires an
original Affidavit of Publication prior to payment for newspaper
advertising. Please send the affidavit, an original copy of the
published notice, and an original invoice to Portia Rochelle,
Division of Coastal Management, P. O. Box 27687, Raleigh, North
Carolina 27611.
Thank you for your assistance in this matter. If you should
have any questions, please contact me at our Morehead City
office.
Sincerely,
v , �
s L. Mercer
Field Representative
JLM/dh
Enclosure
cc: Charles S. Jones
George Hillebrand
Cathey Cottle
P.O. Box 27687, Raleigh, North Carolina 27611-7687 Telephone [phone]
An Equal Opportunity Affirmative Action Employer

CAMA PERMIT NOTICE
Pursuant to NCGS 113A-119(b), the North Carolina Division of
Coastal Management,'an agency authorized to issue CAMA permits in
Areas of Environmental Concern, hereby gives NOTICE that on April
21, 1988, The City of Jacksonville applied for a CAMA permit to
allow construction of a 24 inch stormwater pipe (RCP) and catch
basin adjacent to the New River, behind Ann Street, Between
Bridges and Tallman Streets, in Jacksonville, Onslow County.
The. application may inspected at City..Hall._..or_:.at:.,the
address below. Public comments received by May 10, 1988 will be
considered. Later comments will be accepted and considered up to
the time of permit decision. Project modifications may occur
based on further review and comments. Notice of the permit
decision in this matter will be provided upon written request.
James L. Mercer
Field Representative
Division of Coastal Management.
P. O. Box 769
Morehead City, NC 28557
Phone: [phone]
PLEASE PUBLISH ON: Tuesday, May 3, 1988

MEMORANDUM:
TO: CATHEY COTTLE
FROM: JAMES L. MERCER
SUBJECT: CAMA MINOR DEVELOPMENT PERMIT #100-88 - CITY OF
JACKSONVILLE.
DATE: APRIL 29, 1988
Attached you will find a check for $25.00 which represents the
permit fee for a CAMA Minor Development Permit prepared by our
office for the City of Jacksonville (Permit #100-88).
Also attached is a copy of the Public Notice we have prepared for
this permit.
JLM/dh
Enclosures
cc: Charles S. Jones

M
State of North Carolina
Department of Natural Resources and Community Development
Division of Coastal Management
512 North Salisbury Street • Raleigh, North Carolina 27611
James G. Martin, Governor
S. Thomas Rhodes, Secretary
Division of Coastal
P. O. Box 769
Morehead City, NC
[phone]
April 29, 1988
Mr. George Hillebrand
Engineering Specialist
CITY OF JACKSONVILLE
P. O. Box 128
Jacksonville, NC 28540
Dear Mr. Hillebrand:
David W. Owens
Director
Management
28557
This acknowledges receipt of your application for CAMA Minor
Development Permit #100-88, a copy of which is enclosed. Also
enclosed is a copy of the Public Notice which will be published
in the Jacksonville Daily News on Tuesday, May 3, 1988.
Enclosed you will find a "Notice of Permit Filing" postcard which must
be posted at the property of your proposed development. You should
post this notice at a conspicuous point along the property where it
can be observed from a public road. Some examples would be: Nailing
the notice card to a telephone pole or tree along the road right-of-
way fronting the property; or at a point along the road right-of-way
where a private road would lead one into the property. Failure to
post this notice could result in an incomplete application.
If you have any questions, please contact me at my Morehead City
office, 919/726-7021.
Sincerely,
James L. Mercer S�
JLM/dh Field Representative
Enclosures
cc: Charles S. Jones
George Hillebrand
Cathey Cottle
P.O. Box 27687, Raleigh, North Carolina 27611-7687 Telephone [phone]
An Equal Optxrrtunity Affirmative Action Employer

i
JGENERAL INFORMATION
1. LAND OWNER
Name �i✓�.L.ot�/ C .OIJ/✓T y
Address JV
CityState /VC' Zip �-`'� Phone / I9 IV7 2/7/7
2. AUTHORIZED AGENT
Z
Address �/TY xA/_4 �a
e_
1,
�Y/� State /�/ • p
City Zi/
3. LOCATION/DESCRIPTION OF PROJECT �aZ
e NeuV L�od��y i/.. 417/, •5 r6/Q5 hZ4_ `'
4 ON
EAS OF ENVIRONMENTAL CONCERN (AEC) CLASSIFICATI
(To be filled in by Local Permit Officer prior to completing application.)
Ocean Hazard ksEstuarine Shoreline Other
5. PROPOSED USE
Residential Commerical/Industrial Other
6. SIZE OF BUILDING IN SQUARE FEET:
7. SIZE OF SITE IN SQUARE FEET:
2o�h -�7pri /
This application includes: general information (this This the day of
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...
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 sugges-
tion to help you complete your project as quickly as
possible.
19.E
(or authorized agent)
Indicate below address and phone if not shown above.
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:
LOCALITY
I RMIr NUMBER !/✓ r W
/Q

_r
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 interest ,
in the real property described therein. This interest cane be described as follows: (check one)
an owner of record title, Title is vested in
see Deed Book zf ,page in the
m/=/off County Registry of Deeds.
an owner by virtue of inheritance. Applicant is an heir to the estate of
; probate was in
County.
X if other interest, such as written contract or lease, explain below or use a separate sheet
attached to this application.
rryiS t -f'iiy T�ri�7�JAA - �vA Tn .� / �i/
NOTIFICATION OF ADJACENT PROPERTY OWNERS
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.
(Name)
(2)
(3)
(4)
(Address)
M
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 1
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 70
3
concerning stabilization and flood -proofing techniques.
Z
c
PERMISSION TO ENTER ON LAND f
I furthermore certify that 1 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 2U day of
Lan owner or person authorized to act as his agent
for urposes of filing a CAMA application.

I
rn
VD e JO J paaint)aa uollewJoJul �uln+o o . ` new �uin%eap OLI-L 'liwiad lu. ana liwaad
II l Il sapnlaui ui,�eap airs inoA gins o�rw P �oldutw
---- --- ICI 1 V "17 I I 'l ►� I !11 1 v -� I� i �� � � r-1 I A n v
TNLLMRN STREET
rrT
I NI
' m
o ;K �° m
A Z I7z
a
m O
I � C
X
n -10 i
4 0Ln
rrff
e m /
A
i
z iir=
J -
Apt
3
6g

C,0
CITY OF JACKSONVILLE
.R-P.O. BOX 128
_JACKSONVILLE, N.C. 28541.0128
vM CYP t.BttJ�
VOID AFTER 90 DAYS
PAY F_
TO THE N.C. Division of Coastal Mgmt.
°OFR P.O. BOX 769
Morehead City, NC 28557
WACHOVIA BANK __63
6 TRUST COMPANY, N.A. 531 ' No. 09570
Jacksonville, N.C.
DATE CHECK NO. AMOUNT
April 20, 1988 .09570 $25.00
7
111009570110 11:053 10350 1l:
t
FINANCE DIRECTOR
'THIS DISBURSEMENT HAS BEEN APPROVED AS REQUIRED BY THE
LOCAL GOVERNMENT BUDGET AND FISCAL CONTROL ACT."
'4
;;AU T HOPIZEO SION ATUPE jf
�o.t.3e.:.Lta.t.i.:.�.:.t...:..:.....•...:.: I :..,.:.�.:.:.....::.:.L..:.: .La•e.:.i.:.t.,.:_.:.u.t.l�.e�r.
4 18 1 0008 20v

GENERAL INFORMATION
1. LANDOWNER
Name <:7,)1V_516,k1 C oC_,/-'y /V7
Address jv //-� H -,1,E /
City-- /i�G'G�C�.�Di, /Y/� State IV. Zip Phone
2. AUTHORIZED GENT
Address
,d
City State /v • If. Zip ;0-!?.5W %
3. LOCATION/DESCRIPTION OF PROJECT
4. AREAS OF ENVIRONMENTAL CONCERN (AEC) CLASSIFICATION
(To be filled in by Local Perm/it Officer prior to completing application.)
Ocean Hazard Estuarine Shoreline Other
5. PROPOSED USE
Residential Commerical/Industrial Other C1 /
6. SIZE OF BUILDING IN SQUARE FEET: N�A
7. SIZE OF SITE IN SQUARE FEET: ¢' X 2;f
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...
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 LAMA, only : sugges-
tion to help you complete your project as quickly as
possible.
This the 2ofh day of
19 '
Ap licant's si nature (or authorized agent)
Indicate below address and phone if not shown above.
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:
LOCALITY
RM1T NUMBER

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 interest
in the real property described therein. This interest can be described as follows: (check one)
an owner of record title, Title is vested in
/,/, e— , see Deed Book page 6 48 in the
®/=/o County Registry of Deeds.
an owner by virtue of inheritance. Applicant is an heir to the estate of
; probate was in
County.
X if other interest, such as written contract or lease, explain below or use a separate sheet
attached to this application.
To r 7�12E //%%�/?�i�G/JJ� 7�9
NOTIFICATION OF ADJACENT PROPERTY OWNERS
furthermore certify that the following persons are owners of properties adjoining this property. 1 affirm that
have given ACTUAL NOTICE to each of them concerning my intent to develop this property and to apply for
a CAMA permit.
(Name) (Address) (w
(1) /7// ©��.-/f�c'G��JY�/� /I�G' •-ne �s �rcyio�r5✓c��hacvrl J \�
(2) v
(3)
(4)
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
70
particular hazard problems associated with this lot. This explanation was accompanied by recommendations
3
concerning stabilization and flood -proofing techniques. Z
z
c
PERMISSION TO ENTER ON LAND m
1 furthermore certify that I am authorized to grant and do in fact grant permission to the local permit officer a
and his agents to enter on the aforementioned lands in connection with evaluating information related to this
permit application.
This the 20747'7day ofp`� / 19CIt7 . 2
1.
Lan weer or person authorized to act as his agent
for urposes of filing a CAMA application.

1l:ials aVclas CIO.
E
FF---- ------
UrilQD�j
a
Za
U
W LyN
r
w
�pd =
o °
Ul
Z a Dr
\ J o?o
o
( w
( / o� Q
�z
z
cc
�
N�
as
Q
ty
�
%
F
K
x
0
u
I
t� '
�Z
,rt
p
j
J
a
><
m
3
u
i
I�r
I u1
t
LL
—
1
I
_
`n r rvi v
�r
rL� r\LI
---_—`—
make sure your site drawing includes the tiollo�tiin�
rtrincrr developrnent permit. The drawing
Permit
'
b information
Offi-•
may h,� �;,,,,r
required fr>r
, C A!�na

M `- OI�tSLOW COUtATY JAIL
t1.1
0
A
z - cc
-J.
J
yy
'WATLRFTP-0N C `
PARK V/ .�
_ \4 � VIv
FOOT `SCT SACK L%vAp- .n
_SULHti AD BQARD. .WALK
PRZO PO SE D
�1F.. 5TO1zM DRA I N
LA ;
L
LEM
.-
aN5L,bkv COUNTY COURT.14005E
W
N
w
t7
iD
i W
co L�
coCY)
i J
•
N
•
cr. ;
C►. i
=__C2XISTIKG � �
•
Z4".RCP __ 5D
\ D�LLE'lIEfZ. �r{oUSE
-6L0
\ �
. ' -
_ S1TE �S2AW \tSG
ANNfi STREET PROJECT
FoIZ
-:: cAMA M%i.IOQ . DfiYELOPMENT
. -- A - I/ C

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 interest
in the real property described therein. This interest can be described as follows: (check one)
an owner of record title, Title is vested in O-2X�/-✓
�� �• see Deed Book page 48 in the
County Registry of Deeds.
an owner by virtue of inheritance. Applicant is an heir to the estate of
; probate was in
County.
_ Y if other interest, such as written contract or lease, explain below or use a separate sheet
attached to this application.
rrrlIs C'©rc.T�rrJG' �70� tS zZo r T ,e
NOTIFICATION OF ADJACENT PROPERTY OWNERS
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)
(1) e Xy ©Fe,9 Yi/1 , /1�C L-_Sv�e_ e5aS �r� yious/�,.�hacvr�
(2)
(3)
(4)
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.
Z
c
PERMISSION TO ENTER ON LAND W
furthermore certify that I am authorized to grant and do in fact grant permission to the local permit officer a
and his agents to enter on the aforementioned lands in connection with evaluating information related to this
permit application.
This the 20Mday of p`/ , 19A. (�\
Lan wner or person authorized to act as his agent
for urposes 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?
SITE NOTICE POSTED
SITE INSPECTIONS
DATE OF ACTION:
ISSUED
EXEMPTED
FOR STAFF USE
FINAL INSPECTION
FEE RECEIVED
DENIED APPEAL DEADLINE (20 days)