84-058_Liverman, W. Thomas_19841111 (2)

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GENERAL INFORMATION
LANDOWNER
Name
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Address
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City
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./2. AUTHORIZED AGENT
Name
Address
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Zip '1► 1✓
l��-1 Phone
City ,�:�� t� State
v3. LOCATION/DESCRIPTION OF PROJECT
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4. AREAS OF ENVIRONMENTAL CONCERN (AEC) CLASSIFICATION
(To be filled in by Local Permit Officer. prior to completing application.)
Ocean Hazard V"' Estuarine Shoreline
Other
5. PROPOSED USE
�L,'—'**' Residential Commerical/Industrial Other
6. SIZE OF BUILDING IN SQUARE FEET:
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7. SIZE OF SITE IN SQUARE FEET: ✓ r� �'� �^ 1>�
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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.
✓ This the 1—day of
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Applicant's gnature (or authorized agent)
Indicate below address and phone if not shown above.
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:

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
see Deed Book�13 1in the
, page
\� County Registry of Deeds.
an owner by virtue of inheritance. Applicant is an heir to the estate of
probate was in County.
if other interest, such as written contract or lease, explain below or use a separate sheet
attached to this application.
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NOTIFICATION OF ADJACENT PROPERTY OWNERS
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1 furthermore certify that the following persons are owners of properties adjoining this property. I affirm that
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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)
ell
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FOR DEVELOPERS IN OCEAN HAZARD AND ESTUARINE SHORELINE EROSION AREAS:
1 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
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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
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permit application. _
t-�`This the _day of ��� `'`% , 19
Land owner or -person authorized to act as his agent
for purposes of filing a CAMA application.

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NOTE - IIUv.?f NOT CIAK G INFIFLL.
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.OF: LOT 26, Src7ION n'--
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TOWN OF NAGS HEAD
NAGS HEAD, NORTH CAROLINA 27959
CAMA PERMIT NOTICE
Pursuant to NCGS i13A-119(b), the Town of Nags Head, a
locality authorized to issue CAMA permits in areas of
environmental concern, hereby gives notice that on November
11, 1984, W.:.Thomas . Liverman, the applicant, proposed to
erect a single-family dwelling at lot 26, Section A, Old
Nags Head Cove, in an estuarine shoreline 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 LAMA
Address: P. O. Box 99,
Nags Head, N. C. 27959
Telephone: [phone]
For publication in The Coastland Times, 11-27-84.
Please use Nags Head logo and legal print.