84-0014_Staples, Ronald A. & Phyllis T._19840222

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LAND SURVEYING, ��-� •G. ,`
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�.EWIS JR. CTu'RTIFY THAT UNDER
V, C. P• ION AND SUYla tVISION THIS MAP �C/L/� � �W/L��
1'Y DIRT : L
FIET.D LAND
%U... � _.: i `l lii• � l i�i�i 0. V L' C1,03if•C:.i AS /VZZ/
IS Y:;�Z'v' T �l.a;m i;Il'.i a:1.1' 1':1;; PK�-;P ID,'D II(
ACCOI%DAlft:;: Vil..i C-'� r7—.'.0 AS A?1.�+:):.11.,t�.,�+rtcccrrn, l�/!'//%�! Ilf %✓/l%;
WITYESS MY I!A1iD AND SEAL THIS `' t /..j/!. i2'/1/lL •' f�� it/i 1//`
.: DAY OF —--------- ?— •D�J • .' "., '- 'i�,�yLyE/� /- !� -4 l
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C. —P. LEWIS, );... R. L. S., L-2�14 ;•..y "�t';'�F:���. �>/f /'• AJ.

Dare County/(NRCD)
Local Government
.f
Qn_nnin
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 Ronald A. and Phyllis T. Staples
authorizing developmentin Duck at Lot 25, Phase I, of the Tuckahoe
Subdivision as requested in the permittee's application dated February 1, 1984.
This permit, issued on February 22, 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 done in accordance with attached application and plats.
2. Prior to undertaking any development authorized in this permit, the applicant, or
L:, his authorized.agent, is.required to sign the attached.AEC Hazard Notice
and return it to the Local Permit Officer.
This permit action may 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
i
• Local Permit Officer (signature)
Nelson G. Paul
108 S. Water Street name
Elizabeth City, N. C. 27909
August 22, 1984 [phone] address
In issuing this permit it is agreed that this project is consis-
tent with the local Land Use Plan and all applicable ordinances. .+r
This permit may not be transferred to another party without
the written it
of the Office of Coastal Management. Permitee (signature required if special conditions above apply to permit)

. I
AEC HAZARD NOTICE
YOUR PROJECT IS IN AN:
OCEAN ERODIBLE AREA HIGH HAZARD FLOOD AREA INLET HAZARD 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.
The Commission's rules on building standards,
oceanfront setbacks and dune alteration are
designed to minimize, but not totally eliminate,
property losses from the hazards. By granting
permits, the Coastal Resources Commission does
not guarantee the safety of the development and
assumes no liability for future damage to the
development.
The best available information, as accepted by
the Coastal Resources Commission, indicates that
the annual ocean erosion rate for the area where
your property is located is 22 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. feet landward in a major
storm.
The flood waters in a major storm are predicted
to be about feet deep in this area.
Shoreline erosion control structures (excluding
beach nourishment and berm projects) are not
allowed to be built to protect development built
after June 1, 1979. Limited pushing up of beach
sand is allowed to protect new structures when
they are threatened, but bulkheads, groins, or
jetties may not be used to protect buildings put in
after June 1, 1979.
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.
SPECIAL NOTE: 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) timesfor 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:
djaz..s
ADDRESS:
LOCALITY: CIV •
PHONE:
5C/Rev.6/83

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UNOSURVEYING&PLANNING
LOT a
C. P, T,FC/IS. JR..._ CERTIFY THAT UNDER
MY DIRE: 1011 AND SUYE-'2VISION TIiIS MAP
CAS 1)i11. !! 'Val ::CrUAL FIF.T.D LAND
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f v•a�ai.� 1.•"1 ' r.1 '. �ii lr: Pip T�.':�i.::'1I���"S
IS l:�l" { 9':►' ; !'11C.i �;IP �:1$ Pf;Ei't11J:ll IN �l/T!5 !'/1/f� � T//l_"��l///�E,
AC�0,.11AT.,... tii1. i %� •s1-..0 AS A.l���:)'a.•,�ti.,rr+rr;'h,, i�/!�/i�f �f /..✓/l/; `/%�/1i'%:�/:
WITNESS MY HAND AND SEAL THIS ' � ✓ � . r
-Z_ fv- DAY OF_.cl�� •-----------� — • '•�• /i !3
C. P. LEWIS, ♦u H., R. L. S. , L-2441 • :� ,

An EqualOpportunit Affirmative A tion E'm to er

f •
'} OFFER TO'PURCHASE AND CONTRACT
' t., RFUYIa,ee C{ A . wtie Phe eT : Staptu
r ';`u.yns :... as Buyer,
u er, hereby agrees I
copurchase and W"haotonQmpU
, ..•, .. .... ........... . ......, ....,
j
as Seller
! hereby agrees to sell:and,convey , all of that plot; piece or parcel of land described below, together with all improvements located thereon and such per .i
{ t sonaI property as is listed below (the real and personal property are collectively referred to as "ihe Property"), in accordance with the Standard Provisions,,;.;
' n the REVERSE SIDE 11ERL'OF and upon the following tee,rms an odconditipns:
` , r .I REAL PROPERTY, Located in the City of �L1C12, l� �CLn .L.. 7Uwn1u {1.f P. , . ... , ... , , .. .... , County of .
Dcuee . .. .'.... , State of North Carolina, being known as and more particularly
r' described'as,
StreetAddress:': r n/LL
,' 7 r ,fit ; Legal Description � Qt', U ,, , Phm e .' 7., ..TUckaho ( `
,, .r r •f, , „r 1 `
it' PERSONAL PROPERTY . ... ..... .... j ..
` .1 605.00 0" h . one Thouaand Stix Huncked-Fivel
' '1 PuicHXS PRI F The purchase price is $ , ` J— and shall be aid as follows i
1f 0�00 �b Bu P !
l , (a) $ 1n earnest money paid by :.. , . ... ... ; .. ... .... i
r !r t'1;' it 't rli} ,r (cash; bank,. certified; orpersonal check) with the deliveryof this contract; to be held in escrow by`` ecCCh R PCl �� f
') ;� , f a',,.avrvtaa �7i,,;.,.,. 04.
, Non th.' Qcm- e,na, 7ne. - •-', as agent, until the sale is closed; at which time it will be ,
t.ltcredited co Buyer, or until this agreement is otherwise terminated and it is disbursed in accordance wi[h'the Standard
it xr Provisions on the REVERSE SIDE I-IEREOF
(b) $' n /� Sby assumption of the unpaid principal balance and'all obligations of Seller on they existing loan securedby a deed of inut
the Property;::
/ by a promissory note secured by a purchase money deed of trust on the Property with interest prior to default at the races ;
, of % er annum, P Y a able b a ents of commencing on Prepayment rights if j
it,nri tt t,[j,.r ,tit•+ P Y; P Ym $'
'any, shall be:
' , 4
As umP Lion or transfer ri gy his if an shall be +�
h'
r
j BD''605.00
the balance of the purchase• price in cash at closing;
4 ," " ` ; 4 .CONDITIONSi (State N%A in'each blank of paragraph 4 (a) and 4 (b) that is not a condition to this contract)
The Buyer must be•able to obtain a firm commitment effective through the date of closing fora YI /.a ..... n.
i loan in the principal amount of $ ..... .a ' for a term of n /a year(s), at an interest rate not to exceed .. i� /� . ; % prior ` i '
! f 7 Buyer agrces to use his best efforts to secure such commitment and to advise Seller immediately upon .'
S ! his receipt of the lenders decision. Mortgage loan discount points not to exceed': ; i l i Iu. % of the loan shall bepaid by i
f �, n;/a , , , ,:, ; and loan closing cost shall be paid by .:-
i,t 1;. (b),The„BuyerFmust;be,able,to assume; the unpaid print[ al balance of the existing loan described in paragraph 9(b) above for the re
mainder of the loan term, at an interest rate not to exceed .KEY % fixed or .. n•I u.. .
If such such assumption requires the lender's approval, approval must be granted prior to ..... ; . n/.a; , :'.. Buyer agrees to advise Seller
i P immediately upon his receipt of the lender's decision, In addition to any reasonable transfer fee (see STANDARD PROVISION No. 2), mortgage loan
assu,nption and/or discount points not to exceed # n:/u . shall be paid as follows ..........
�" Vl / a
.... .... .
(c) There must be no restrictions easement, zoning or other governmental regulation that would prevent the reasonable use of the real property for
tictt . , ...:. ' : , u
5 ASSESSMENTS Seller warrants that there are no• encumbrances or special assessments, either pending or confirmed, for sidewalk, paving; purposes.,
sewer or other improvements on or adjoining the Property, except as follows:... Tm.Gkce .Q e
,....... ..... .e............................ ...;., ,.,....
(Insert "none or the identification of any such assessments, if any, the agreement for payment or proration of any assessments indicated is to be set forth
in paragraph 6 below,):',
s• 6. OTHER PROVISIONS AND CONDITIONS: `
t (a) All of the Standard Provisions on die REVERSE SIDE HEREOF are understood and shall apply to this instrument, except the following numbered "
Standard Provisions shall be deleted:.:: .
(If none are to be deleted, state "None" in this blank) '.+
(b►.,; Pa/L.tie�5 o „thL6 contAact aEcogn.ize that the subd.i.vi,6 i.on hays not neee ived- 4inaZ
„a�nnotir�2 'ctnd �thctt no '.conveyance .Can be made untilsuch uppAova2 .is obtained and
t`untie:the:.ptat�,x,6 AeC0)Lded." ,Tn the event,'. 4on• any "neaton ,including. matters within
` the:dinswLetion a• the 4elZeA, :the .-,subdivii6ion doer not achieve 4inae•appA'ovat
and/O)L the;. ptat i s: not )Lecoaded, thbs contxact .6hatt -be _ nuU and void tend ct Pt ,
{�LLndis'depaz.ct2d' haft' be rce{�unded..' ;
Thin cont&ac t .is ,`pried icated upon 13uyen,; be ing ' ccbte'.to obtain a poziti.ve :{ ieid : i.+
evi�eLuctian/��e�Lcotat i,on :tut .to be paid by BuyeA ryLi.on to • ciozing .
(If additional space is nee ed; the bottom of the reverse side of this page may be used)
-7. CLOSING; All parties agree to execute any and all docume I p p s n sary co n with closing and transfer of title on or before
vcgn•cc n� cte, be�Rt i.Ff. ;3�i d �flr'>� Agent t
. rip i/ J at a place designated by . i
Deedis'iobetEuJe�6 KnePuo�th ;�m?,,.j mit o .. tonA
POSSESSION Possession shall be delivered ; ; , : �Qill� l ` , , , in the event that Buyer has agreed
.chat possession is not delivered at closing, then Seller agrees to pay to Buyer the sum of, � ._} .,., ; n/a per day
i ! i tofand including the date that possession is to be delivered as above set forth.`
1 9 COUNTERPA tTS, Thi Offer shall become a binding contract when signed by both Buyer and Seller and is executed in
E 3 '�th/Lee
�t ;,' , :, I±• counterparts with an executed co nc gqait being retained by each party hereto.
rr
,y Dale of.OfferEln , . 7 9 8 ? Date of Acceptaper.. c�V2. .. ,
r 4 i
,Rona,2d ScL ens' " { '
(srai) .C: ��� !-y� ' . (sFAL)
1 llugl6.C.CJu'�r'�S' L / Seller (O er) _-.{ ` {y �'r
,'fC P/?; (Sr Q�C14C..iVW\ WSO16(SEAL),
Buyer ' + Seller (Owner) U... ,
Bn;can Tiucc{dJ./ Ft ctc(y C� R�ALTQRS
I! . SAgcnt%Finn ' {' i,.i, i J, , , Agent/Firm
1 !t I hereby acknowl ga'' cipt of the earnest money herein sec forth in accord, e with the terms hereof.
' t J
Agent/Fi
f1.223-74=0308 By: �� A j.

STANDARD PROVISIONS
V•,
� t, f t r!! t t, ,r 1 �• � r r :.+,. tl,, I l ,� � � F ''
1 1 EARNEST MONEY iln the event this offer is not accepted, ' ;': option of (a) completing them, (b) providing for their completion
or in the event that any of ,l a conditions hereto are not satisfied; or'- • or (c) refusing to complete them. If Seller elects not to complete the .'
in the event ofa breach of this contract by Seller, then the earnest repairs, [lien Buyer shall have the option of (a) accepting the Prop-,:
moneyshall be`recui to Buyer; but such return shall not affect .,.terry in its, present condition, or (b) terminating the contract, .in
, any other remedies available to Buyer for'such breach. In the event '.~which case the earnest money,shall be refunded. Closing shall con• ;
} l'~this offer is accepted and! Buyer., breaches this contract,` [hen the �; stitute acceptance of the electrical, plumbing, heating and cooling
earnest moncy shall be forfeited; but such forfeiture'shall not affect l _systems and built-in appliances An their. existing condition unless, '`
any ocher remedies available to Seller, for such breach. :provision is otherwise made inwriting pursuant to this paragraph,'-,; `
1 -'t t [RECOMMENDATION: Buyer should have any inspections made',
2 LOAN. ASSUMED In the event a loanis assumed as par[ of
` i' ;'the payment of the,purchase;price;Ehen.all payments due from prior to incurring expenses for Closing.],
Seller thereon'.musi be current at closing, and the principal balance , •`: 9.- TERMITES; ETC.: Unless otherwise stated herein; Seller
E assumed shall! •be computed as•of the''date of closing. The amounts f.< shall provide at Seller's expense a report from a'licensed pest con
' , shown+for the assumption balanceandcash at closing shall be ad `i trol operator on a standard form in accordance with the regulations
} J it't justed'^as appropriate:at closing to reflect the final computations of the North Carolina Structural Pest ControC Committee,' stating
Unless:Buyer has otherwise specifically agreed in writing, the ex that there was no visible evidence of wood•descroying'.insects and
iscing loan must be%ass'umable without acceleration of.the am unt `'; that no visible'damage therefrom was observed, 'or, if new construc
I ty secured'orrany change`In the original terms of'the note and'deed of } ' tion'a new'construccion termite bond. All extermination required
r 11' trust',knd without imposition'of any charge, fee"ar, cost to Buyer A'"shall'.be paid'for by Seller and completed prior to closing) unless
i ;;•other than:a reasonable transfer fee orsimilar charge not to exceed • 'otherwise agreed'upon in writing by the,parties..If any structural';;
' $175 00 `The escrow account,'if any;'shall be purchased by B}iyer '~a -repairs are'necessary; Seller shall have the option of (a) paying for
them, or (b) refusing:to pay for them."If Seller elects not to pay,for ,
ti t; 3 PROMISSORY `NOTE AND' DEED OF TRUST; In the,, 'such' structural repairs,: then' Buyer shall have the option of a
' ; eventa promissory note secured by,a deed of trust is given by Buyer +4 ,accepting the Property in its present condition,' or (b) terminating.
t r to Seller as part of the,payment of,the,purchase price, the prom -
the contract, in which latter 'case the earnest money,shall be
t l issory.note, and deed of trust shall be in theform of and contain the
provisions of the promissorynote •tnd deed of trust forms approved "refunded The `inspection and report described in this paragraph '
;by the',N C, Bar'Association as Forms A and 5, as modified in .` may'not reveal; either structural damage or damage caused by
r agents or organisms other than termites arc( wood destroying insects
t =,paragraph 9(6)'on the reverse side „ :
�;: `� ``4 , PROBATIONS AND ADJUSTMENTS, Unless otherwise""-"' 10 LABOR OR MATERIAL Seller shall furnish at closing an
' proYuled, the'follow�ng items'shall .be prorated and' adjusted be +
affidavit and, indemnification' agreement; in form satisfactory to
f + ';[weeri he artier or aid at'dosin x t lr>+ +' 1 : > t Buyer showing that all labor or materials, if any; ,furnished to. the
p,,•,�a, g ,a , i, ,, Property within 120 days prior to the'daie of closing have been paid
f (a�, Ad valorem taxes on real property shall be prorated on a R : and, agreeing to,indemnify Buyer against all loss from any cause or
r, calendar year basis to' the date of closing i g
i ' , , claim arisin therefrom.
(b)d valorem•taxts on personal. property for the enure year FUEL.OIL. Buyer agrees to purchase from Seller the'fuel .'
` sh•tll be paid by Seller: ,q it "
�' '• all, if any; situated in a tank on the premises for the prevailing rate
late listing penalues;,if any,''shall be paid by Seller. g'i'per gallon'with the cost of -measurement thereof, if any, being
(d) Rents, if any for the Property shall be prorated to the date of
'dosing. t +. `� . j borne by Seller.:,
t, < '
(e)`accrued; but runpaid, '.interest and other charges to Seller, if 12..CLOSING EXPENSES. Seller shall pay for�the preparation
' :!'any, shall be computed to the date of closing and paid by Seller; in , of a deed and for the revenue -stamps required by Buyer shall `
c ceresc and othercharges prepaid by Seller shall be credited to Seller „', pay for recording the deed and for preparation and recording of all.
` -.at closing and paid:•by Buyer; (Other charges may include FHA ' instruments required, to secure the balance of the purchase price
mongage insurance ;premiums, '„private . ,mortgage . insurance unpaid at closing
premiums and Homeowner's Association dues.)
I3. EVIDENCE OF TITLE: Seller agrees to exercise his efforis
5; FIRE OR OTHER' CASUALTY -.:The risk of loss or damage by;''• to deliver to Buyer as soon as seasonably possible after the accep'•
fire or:other casualty prior to closing shall be upon Seller. Lance of this offer, copies of all title information in possession of or
CONDITIONS available to Seller,"including, but not limited to: title insurance
r ' policies,"! attorney's opinions on. title, surveys, - covenants, deeds,
(a) The Property must be in substantially the same condition at
note; and deeds of trust and easements relating to the real and per -
dosing as on the date of this offer, reasonable wear and tear .: sonal property' described above.
excepted 5
r (b) "Alf deeds of trust'liens and ocher charges against the Property 14 'ASSIGNMENTS: 'This contract may not be assigned
not assumed by Buyer, must be paid and cancelled by Seller prior without' the written `agreement of all parties; but if the same is
to''or.'at closing rr' �' Ii s . assigned by' agreement, •.then the same shall be binding on the '.
(c) Title must be'delivered' at closing by general warranty deed :' 'Assignee and his heirs.
and'must•be`fee simple marketable title; free of all •encumbrances
15. PARTIES: This contract shall be binding and shall inure co
except ad valorem taxes for the current year (prorated to`date of the benefit `of the parties and their heirs, successors and'assigns:`'
`. closing), utility easemcnts�anclunviolated restrictive covenants that ,•
\The Provisions "herein' contained with respect to promissory notes .
f do not. materially affect the value of the Property and such other •'
and deeds of, trust shall be binding upon and shall inure to the
encumbrances ; as may be ;assumed or •specifically approved by:!,benefit of all parties'to the same as well as subsequent owners of the
I;Buyer:'The subject Property must have legal access to a.public '
Property and the said notes,• and s usehere
deeds of trust. As in ti,
right of way c' i
f, words in the singular include the plural and the masculine includes/
If a portion of the purchase price for the Property is being the feminine and neuter genders, as appropriate t
paid by assumption'of an existing loan and if the lender requires ics' ; !;. + i ,.
approval for the assumption, then the approval of the Lender; after 1' vl.,r.16 .SURVIVAL, Any provision herein' contained which•by its
,+ cullgent 'ipplieacion the'refor�by Buyer, is a condition of this contract ' .-, nature and effect if required to be observed, kept or performed
Y after the closing shall survive the closing and remain bindingupon
all charge
7 NEW LOAN Buyer, shall be responsible for s made
Iluyertwith respect to any new loan' obtained by Buyer and Seller
performed and for the benefit of the parties hereto until fully observed kept or'':
y, shall liave no obligation to'pay any, ciiscountfee or other charge in,:..
connection` therewuh unless specifically set forth' in this contract 17. ENTIRE AGREEMENT Buyer acknowledges that'he has.;...
inspected the above -described property. This contract contains the
B ,;UTILITIES ,Unless :otherwise stated herein, the electrical
entire agreement of the parties and there are`no representations
r plumbing,.`heacing and cooling system's'and built-in'appliances, if, •
inducements,,'or other .provisions other; than those expressed, in
'any shall be in good:working order at closing, Buyer has the option '' writing. ''All . changes, additions or . deletions' hereto must, be in `.
to have'the same inspected b a reputable inspector or contractor at
r p Y p p y. writing and signed by all parties.'Nothing herein contained shall
r Buyer;s expense but:such inspections must be completed in suf alter'any agreement between a REALTOR and the Seller as con
ficient time before'dosmg so as to permit repairs, if any, to be tom ' i° ; .
+ + tamed in any listing contract or other'agreement between them
K t pleced'by closing,. If any repairs are necessary, Seller shall have the
(CONTINUATION OF OTHER CONDITIONS FROM REVERSE SIDE' 1F APPLICABLE)
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HUNTER HOMES, INC.
Rt. 1 Box 828 - Kill Devil Hills, N.C. 27948 - Phone: [phone]
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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
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) IP
an owner of record title, Title is vested in
, see Deed Book , page in the TJ
County Registry of Deeds.
�trt
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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O
n
NOTIFICATION OF ADJACENT PROPERTY OWNERS
I 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 It,a CAMA permit.
(Name) (Address) y
fi
KNW 19 9
(2) %,<A&. S,4e �; c��c W� s�.� Yo Ce—O P Sa.�,�u�s coin ko,n, Wa &L- N. C . -17 8; O
(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 i
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 a
3
concerning stabilization and flood -proofing techniques. .�
z
PERMISSION TO ENTER ON LAND 3
I furthermore certify that I am authorized to grant and do in fact grant permission to the local permit officer o
and his agents to enter on the aforementioned lands in connection with evaluating information related to this
permit application. JJ
This the day of �e� , 19�. i -
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?
9 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)