Not Given_Beach Realty of North Carolina, Inc._19850424

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ill GENERAL INFORMATION MAY1718
P 1. LAND OWNER«• �-•
min p i
Perr Na me ��1ACl'\QQ�� o �-\ �_a. n c� _ 1 ►r1 C ,
PHti Address C> 1. 338
City&EL d"' )k State Zip _ 0'7G Ll9 PhoneC�1 a(o�-3��.5
2. AUTHORIZED AGENT
PH) Name ' zeLG�'1 K. a� �(y► S � � 7� fit:
Address �J 7I ax
City h� ' �� t � State N C Zip , �a L�cl Phone o9 Co l -DSO S
It. - L
3. LOCATION/DESCRIPTION OF PROJECT 0 1-7n O C fe C)OU�G1 �,1-Y1
Y c
_ 4. AREAS OF ENVIRONMENTAL CONCERN (AEC) CLASSIFICATION
(To be filled in by Local Permit Officer prior to completing application.)
DE' —� Ocean Hazard Estuarine Shoreline Other
5. PROPOSED USE
Residential Commerical/Industrial Other
6. SIZE OF BUILDING IN SQUARE FEET: % 7 %Iyt t1! 0AL0..
7. SIZE OF SITE IN SQUARE FEET: 171,170 �• T '
NO
This application includes: general information (this Thi e r day of
F form), 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 �-
to the locality, and any information as may be pro-
vided orally by the applicant. The details of the applica- Applicant's signature (or authorized agent)
tion as described by these sources are incorporated
without reference 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-
a strative action.
SITE
SITE
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:

110
..STATEMENT OF OWNERSHIP
1, 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 C CL a '+L__
/l a rl C ; see Deed Book 1 g , page S !y in the
j��✓i 2 County Registry of Deeds. N /�°� 3 :5 i
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.
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) (Address)
(Z)� 01e)c. 7I a C.
(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,rsusceptible 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 the day of �-� --, 19 gar
v
Land owner or person authorized to act as his agent
for purposes of filing a CAMA application.