WO-25-12_Wiloughby, R.L._20121212

`Jan. 8. 2013 2:18PM CARTERET CO WESTERN OFFICE No.3068 P. 3
L �
Carteret Count WO.25.12
Local Government Permit Number
CAMA
MINOR DEVELOPMENT
PERMIT
as authorized by the State of North Carolina, Department or Environment,
and Natural Resources and the Coastal Resources Commission for development
in an area of environment concern pursuant to Section 113A-118 of the
General Statutes, "Coastal Area Management'
Issued to R.L. Willoughby, authorizing development In the Estuarine Shoreline - ORW (AEC) at 121 Hollings Court, in
Newport, NC Carteret County, as requested in the permittee's application, dated 11/28112, This permit, issued on
1212/12, 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.
This permit authorizes: Construction of single-family dwelling, driveway, swimming pool with concrete apron, decking, retaining wall
with fill and fencing
(1) All proposed development and associated construction must be done in accordance with the permitted work plat
drawings(s) dated received on 11/29112.
(2) All construction must conform to the N.C. Building Code requirements and all other local, State and Federal regulations,
applicable local ordinances and FEMA Flood Regulations,
(3) Any change or changes In the plans for development, construction, or land use activities will require a re-evaluation and
modification of this permit.
(4) A copy of this permit shall be posted or available on site. Contact this office at 2521393-3204 for a final inspection at
completion of work,
(Additlonal permit Conditions on Page 2)
This permit acport may be appealed by [he permittee or other qualified persons
within twenty (20) days of the Issuing dale. From the date of an appeal, any
work conducted under this permit must ruse unlit 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
modification not covered under this permll, require further written permit
approval. All work must cease when this permit expires on
DECEMBER 31, 2015
in Issuing [his permit it is agreed Thal this project Is consistent with the local Land
Use Plan and all applicable ordinances. This permit may not be transferred to
another party without the wdtten approval of The Division of Coastal
Management.
(Ut
Sammy Graham
CAMA LOCAL PERMIT OrPICIAL
701 Cedar Point Blvd
Cedar Point, NC 28584
XJ. !/.uLtdlsi�
PERMITTEE
(Signature required if conditions above apply to permit)

Jan. 8. 2013 2;18PM
Name: R.L. Willoughby
Minor Permit # WO.25.12
Date:12112/12
Page 2
CARTERET CO WESTERN OFFICE
No.3068 P. 4
(5) The amount of impervious surface shall not exceed 25% of the lot area within 575 feet of Normal High Water
(Estuarine Shoreline.- ORW Area of Environmental Concern), in this case, 3900 square feet is authorized per State
Stormwater Permit SW8060516.
(6) Unless specifically allowed in 15A NCAC 07H. 0209(d)(10), and shown on the permitted plan drawing, all
development/construction shall be located a distance of 30 feet landward of Normal High Water. No portion of the
roof overhang shall encroach into the 30 ft. buffer.
(7) All unconsolidated material resulting from associated grading and landscaping shall be retained on site by effective
sedimentation and erosion control measures. Prior to any land -disturbing activities, a barrier line of filter cloth must
be Installed between the land disturbing activity and the adjacent marsh or water areas, until such time as the area
has been properly stabilized with a vegetative cover.
(8) All other disturbed areas shall be vegetatively stabilized (planted and mulched) within 14 days of construction
. completion. '
1
SIGNATURE: ` Z' .Z �� DATE: /' a?o�az
PEPWITTEE

' Dec. 3. 2012 3:58PM CARTERET CO WESTERN OFFICE - N _ ,�. f I No. 2900 P. 2
Locality
Pemut 1Number u -h — 125
—1/2—
Ocean hazard Estuarine Shoreline ORW Shoreline Public Trust Shoreline Other
,GENERAL I NFo ivMAT ]N
LAND OWNER
Name Royce L. Willoughby
Address 3021 Oak Bridge Drive
City �
Email [e-mail]
AUTHORIZED AGENT
(For official use only)
State NC Zip 27610 Phone [phone]
Name Kathy B. Vinson AICP, Coastal Planning Services, Inc.
Address P.O, Box 827
City Morehead City
State NC Zip 28557
Email [e-mail] `
Phone [phone]
LOCATION OF PROJECT: (Address, street name and/or directions to site. If not oceanfront, what is the name of the
adjacent waterbody )121 Hollings Court (Cannonsgate at gogue Sound), Newport, NO
DESCRIPTION OF PROJECT: (List all proposed construction and land disturbance.) please see attachment.
SIZE O- LOW/PARCEL.- 15,162.40 square feet .35 acres
PROPOSED USE: Residential [D (Single-family ❑ Multi -family [] ) Comm erciaVlndustrial [l Other
COMWLETE EITHER (1) OR (2) BELOW (Contact your Local Permit Officer (fyou are not sure which AEC applies
to your property):
(1) OCEAN HAZARD AECs: TOTAL FLOOR AREA O'F PROPOSED STRUCTURE: n/a square feet (includes
air conditioned living space, parking elevated above ground level, uoa conditioned space elevated above ground level but
excluding non -load -bearing attic space) r
1
(2) COASTAL SE(ORELINE AECs: SIZE OF BUILDING FOOTPR'INTAND OT HER IMPERVIOUS OR )BIALT
UPON SURFACES: 3,895 square feet (includes the area of the roof1drip line of all buildings, driveways, covered decks,
concrete or masonry patios, etc. that are within the applicable AEC. Attach your calculations with the project drawing.)
STATE STORMWATER MANAGEMENT PERMIT; Is the project located in an area subject to a State Stormwater
Management Permit issued by the NC Division of Water Quality?
YES= NC=
If yes, list the total built upon arealimpervious surface allowed for your lot or parcel: 3900 square feet.

Dec. 3. 2012 4:OOPM CARTERET CO WESTERN OFFICE No.2900 P. 15
4TMR'PERMITS MAY BE REQUMED: The activity you are planning may require permits other than the CAMA
minor development permit, including, but not limited to: Drinking Water Well, Septic Tank (or other sanitary waste
treatment system), Building, Electrical, plumbing, Heating and Air Conditioning, Insulation and Energy Conservation, FIA
Certification, Sand Dune, Sediment Control, Subdivision Approval, Mobile Home ?ark Approval, flighway Connection, and
otiuers. Check with your Local permit Officer for more information.
STATEMENT OF OWNERSHIP:
1, the undersigned, an applicant for a CAMA minor development permit, being either the owner of property in an AEC or a
person authorized to act as an agent for purposes of applying for a CAMA minor development permit, certify that the person
1 isted as landowner on this application has a significant interest in the real property described therein. This interest can be
described as: (check one)
Zan owner or record title, Title is vested in koyce L. Willoughby, Jr. see Deed Book 1418
page : 451t453 in the Carteret County Registry of Deeds.
Dan owner by virtue of inheritance. Applicant is an heir to the estate of
probate Nvas in County.
F—If other interest; such as written contract or lease, explain below or use a separate sheet & attach to this application.
NOTIFICATION OFADJACENT PROPERTY OWNERS:
I furthermore certify that the following persons are owners of properties adjoining this property. I affnn 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) Myron Keith and Wendy Maready, 972 Van -Geri Drive, Winterville, NC 28590
(2) Virginia Warehousing, LLC, P.O. Box 11360, Goldsboro, NC 27532
(3)
(`1)
ACKNOWLEDGEMENTS
I, the undersigned, 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 particu-
lar hazard problems associated with this lot, This explanation was accompanied by recommendations concerning stabiliza-
tion and floodproofing techniques.
I furthermore certify that I am authorized to grant, and do in fact grant; permission to Division of Coastal Management staff,
the Local Permit Officer and their agents to enter ort the aforementioned lands in connection with evaluating information
related to this permit application.
Landowner or
This the 28th day of November 20 12
authorized to act as his/her agent for purpose of filing a CAMA,pennit application
This application includes: general information (this form), a site drmi�ing as described on the back of this application, the
ownership statement, the Ocean Hazard AEC Notice where necessary, a checkfor S100.00 made payable to the locality, and
any irzformrution as may be provided orally by the applicant. The details of the application as described by these sour-ces are
incorporated without deference in anypermil which may be issued Deviation from these details will constitute a violation of
any permit, Anyperson developing in anAE'C without perms l is subject to civil, criminal and administrative action.

Dec. 3. 2012 3:58PM
CARTERET CO WESTERN OFFICE No.2900 P. 3
Jim Jennings, AICP
Director
Carteret County
Department of Planning and Development
Main office:
302 Courthouse Square
Beaufort, NC 28616-6709
Tel: [phone]or 728-8545
Fax: [phone]
CAMA PUBLIC NOTICE
Western Office:
701 Cedar Point Blvd.
Cedar Point, NC 28584-8013
Tel: [phone]
Fax: [phone]
Pursuant to NCGS 113A-119(b), Carteret County, a locality
authorized to issue CAMA permits in areas of environmental
concern, hereby gives notice that on November 29, 2012, Kathy
Vinson of Coastal Planning Services, Inc., agent for R.L.
Willoughby, applied for a LAMA Minor Permit to construct a
single-family dwelling, driveway, swimming pool with concrete
apron, decking, a fence surrounding the swimming pool area,
retaining wall and add fill, on his lot in the ORW Estuarine
Shoreline AEC located at 121 Hollings Court, Newport, NC.
The application may be inspected at the address below.
Public comments received by December 12, 2012, will be considered
up to the time of permit decision. Project modifications may
occur based on further review and upon comments. Notice of the
permit decision in this matter will be provided upon written
request.
Tracy Barnes
LAMA local Permit Officer
Carteret Counter
Western Permit Office
701 Cedar Point Boulevard
Cedar Point, NC 28584
Please publish on:
Sunday, December 2, 2012
Request to return Affidavit of Publication
as soon as possible,

'Dec. 3. 2012 3:58PM CARTERET CO WESTERN OFFICE No.2900 P. 4
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Dec, 3. 2012 3:58PM CARTERET CO WESTERN OFFICE No.2900 P. 5
R.L. Willoughby
3021 Oak Bridge Drive
Raleigh, North Carolina 27610
August 28, 2012
To Whom It May Concern;
I authorize Kathy Vinson, AICP to represent me and apply for CAMA permits to develop
my property consisting of combined Iots #484 West and 4485, Cannonsgate at Bogue
Sound, Newport, Noah Carolina, This authorization extends to all permits and
authorizations required by local, state, and federal agencies that may be required as part
of the permitting, process.
I also authorize release of information related to the project site to Ms, Vinson; including
boundary surveys, topographic maps, and results of wetland delineation and soil
permeability tests.
If you have questions or need additional information, please feet free to contact me at
[phone].
Sincerely,
R.L. Willoughby

Dec. 3. 2012 3:59PM CARTERET CO WESTERN OFFICE No.2900 P. 6
PROJECT DESCRIPTION
Royce L. Willoughby
121 Hollings Court
Cannonsgate at Bogue Sound
November 2012
Royce Willoughby is the owner of property located at 121 Hollings Court in Cannonsgate
at Bogue Sound, The property consists of Lot 485 and the west half of original Lot 484.
The recently combined lot is now identified on the Carteret County website as Lot 485,
The property is located within the CAMA 575' Coastal Shoreline Area of Environmental
Concern (AEC). Areas of coastal and 404 wetlands, as delineated and approved by the
US Army Corps of Engineers and the NC Division of Coastal Management, are present
and shown on project plans.
Mr. Willoughby is requesting a minor CAMA permit for construction of a single-family
residence with driveways, a swimming pool with fence and associated pervious decking,
and elevated pervious walkways. The project also includes grading and filling of the lot,
construction of:a retaining wall, and landscaping.
Impervious areas associated with the house and swimming pool include masonry steps on
the front of the house, 4' overhang above garage doors and 1' roof overhang above the
third floor, 20' diameter semicircle patio at the back of the house, H VAC concrete pad,
2' pool apron, and driveway connections to Hollings Court.
Pervious features requested include a 6' wide slatted wood (or similar material) deck
surrounding the pool and extending from the concrete apron. A, 4' x 20' pervious
walkway will extend from the patio to the edge of the pool deck. Another walkway
measuring 4' x 19.2' will extend from the pool deck to the edge of the retaining wall.
Pervious steps and landing are also located on the west side of the house.
A fence surrounding the pool and deck, constructed to meet applicable regulations, is also
planned. Landscaping of the lot is also proposed as shown on project plans.
The proposed fill area measures 60' x 80' as shown on the plans. No fill will be placed in
wetlands. The proposed retaining wall will be located along the entire width of the
property ( 60') to contain the fill and prevent seepage into wetland areas.
The maximum allowable built -upon area (BUA) or impervious surfaces per lot for
Cannonsgate Lots 483 — 514 is 2600 square feet, as specified in the Declaration of
Protective Covenants and Architectural Guidelines of the subdivision (applicable pages
from these documents are attached). Mr, Willoughby's combined property contains 1.5
lots for a total allowed BUA o£3900 square feet.

'Dec. 3. 2012 3:59PM CARTERET CO WESTERN OFFICE No.2900 P. 7
Project plans include 2,324 square feet of BUA for the house (including steps, overhangs,
and HVAC pad). Driveways and road connections contain 1,251 square feet of BUA. The
backyard patio and impervious pool apron comprise 320 square feet, for a total project
BUA of 3,895 square feet.
The size of the project site is 15,162 square feet or .35 acre. As such, the maximum
disturbed area for the project falls below the threshold for triggering a State erosion and
sedimentation control plan.
The proposed plan meets Carteret County setbacks and the 30-foot CAMA buffer.
Additionally, the house is sited to meet Cannonsgate at Rogue Sound side yard setbacks
of 10' that apply to combined lots,
Adjacent riparian property owners (Myron Keith Maready and Virginia Warehousing
LLC) have been notified of the proposed plans by certified mail. Receipts for the certified
mail notices are included with this application,
An elevated slatted walkway over wetlands, measuring 4' x 70', is proposed beginning at
the retaining wall and extending to the waterward edge of marsh. A 10' octagon
observation gazebo is proposed to extend over the water at the end of the walkway.
Other than this elevated walkway and gazebo, no development is planned within wetland
areas, Please note that the wetland walkway and gazebo are not included in the minor
CAMA permit application. The owner is requesting a general CAMA permit from the XC
Division of Coastal Management for construction of these project components.

Dec, 3. 2012
3:59%15, ARTERET CO WESTERN OFFICE �esdr:e�.'r,� L'uvY� No. 2900
4 n Y--.S
Stormwater Management Regulation;
(a) Which is intended to ensure ongoing compliance With State Stormwater
Management Permit Number S $O QS M, as issued by the Division of Water Quality
under NCAC 2H.1000,
(b) The State of North Carolina is made a beneficiary of these covenants to the extent
necessary to maintain compliance with the stormwater management permit,
(c) These covenants are to run with the land and be binding on
claiming under them. ail persons and parties
(d) The covenants pertaining to stormwater may not be altered or rescinded without the
express written consent of the &ate of North Carolina. Division of Water Quality.
(e) Alteration of the drainage as ,shown on the approved plan may not take place
without the concurrence *of the Division of Water Quality.
(t) The maximum allowable built -upon area per lot is as follows;
Lots 1-304, 347-368, 376-426: 3200 square feet
Lots 305-346, 483-514: 2600 square feet
Lots 369-375, 427-482, 515-525: 3000 square feet
These allotted amounts include any built -upon area constructed within the lot property
boundaries, and that portiort of the iright-of-way the front lot line and the edge
of the pavement. Built upon area includes, but is not limited to, structures, asphalt,
concrete, gravel, brick, stone, slate, coquina and parking areas, but does not include
raised, open wood decking, or the water surface of swimming pools.
(g) This project proposes a curb outlet system. Each designated curb outlet swale
shown on the approved plan must be maintained at a minimum of 100, long with 5:1
.(Hz ) side slopes or flatter, have a longitudinal slope no steeper than 5 %, carry the
flow from a 10 year storm in a non -erosive manner, and maintain a dense vegetated
cover.
(h) Filling in or piping of any vegetative conveyances (ditches, swales, etc.) associated
with the development except for average driveway crossings, is strictly prohibited by
any persons.
(i) Each lot will maintain a 30' wide vegetated buffer between impervious areas and
surface waters.
0) All roof drains shall terminate at least 30' from the mean high water mark of
surface waters.
(lc) pilling in, piping or altering any designated 5:1 curb outlet swale associated with
the development is prohibited by any person,

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B. i\'lodifications to existing homes must commence construction within four months of the approval of the
application by the CANNONSGATE ARC. If no maximum time period is specified in the approval ox any
other agreement, constriction of an addition shall be completed within four months of CANNONSGATE
ARC approval of the staking plan. The Applicant may request an extension of up to two months if
requested not less than thirty days prior to the expiration of the maximum time period, which the
CANNONSGATE ARC tuay approve or disapprove, is its sole discretion.
C. If construction is to be halted for a period of (30) thirty days or longer, then -written notice shall be given to
the CANNONSGATE ARC with an explanation of the cause of the delay and the plans to remedy any
problems. The CANNONSGATE ARC may then require certain additional measures to be taken.
D. If construction is not completed within the period allowed, the approval shall be deemed withdrawn, and the
incomplete construction shall be deemed to be in violation of the Declarations and these Guidelines.
3.12 Change After Approval: All proposed changes to structures, including changes that affect the exterior of any
building, colors, windooas, doors, grading, paving, utilities, landscaping, or signage, made after the final approval
of plans must be submitted to and approved in writing by the CANNONSGATE ARC prior to implementation.
Close cooperation and coordination between the Applicant and the CANNONSGATE ARC will ensure that
changes are approved in a timely manner. If Carteret County or any other authority having jurisdiction requires
that changes be made to final construction plans previously approved by the CANNONSGATE ARC, the
Applicant must notify the CANNONSGATE ARC of such changes and receive approval from the
CANNONSGATE ARC prior to implementing such changes.
3.13 Construction Work Day: Contractors shall not be permitted to commence work prior to 7:30 AM, nor work
on exteriox portions of the dwelling past sundown or 6:30 PM, whichever occurs first The exception is that
interior wotk, where noise is not carried to the exterior may be performed until 8:00 PAL No work is permitted
for any purpose on Sunday or on holidays observed by the State of North Carolina.
ARTICLE 4 -- SITE REQUIREMENTS.-
4.1 Impervious Area: All lot improvements (driveways, walkways, building footprints, fencing, patios, etc)
with the exception of raised wood decking and the water surface area•of pools, must be within the allowable
impervious area assigned to each lot as indicated below:
Lots 1-304, 347-368, 376-426: 3200 square feet of total impervious area allowed
Lots 305-346, 483-514: 2600 square feet of total impervious area allowed
Lots 369-375. 427-482, 515-525. 3000 square feet of total impervious area allowed
The following rules apply to the calculation of impervious area in Cannonagate
at Bogue Sound;
1. The full building footprint must be counted as impervious or Built Upon Area (BUA).
2. The area under roof overhangs shall be counted as BUA. Downspout extensions must stop at least W from
& lea n High Pater (1 ffi )) to allow an opportunity to sheet flow.
3. The full area under covered porches even if it covers pervious decking is considered BUA.
4. Garden or retaining walls covering more than 100 SF arc to be calculated as BUA. Where all walls on the site
have a total footprint of less than 100 SF, they are exempt from the calculation.
5. Concrete driveways, patios and utility pads (FiVAC equipment and electrical transformers placed on pads on
the ground) are to be counted in the BUA calculation.
6. Permeable pavement cannot receive credit under the current Cannonsgate permit and must be considered as
BUA in the calculation.
7. Sidewalks and driveways are considered BLU, with the following stipulation: Sidewalks which are constructed
by the developer adjacent to roads that have been constructed by the developer as shown on the approved plat
Cmnonsgate at Bogue Sound Architectural Guidelines
November 6, 2007 Edition Revision 2-11
Page 8 of 26

.Dec. 3. 2012 3:59PM CARTERET CO WESTERN OFFICE No.2900 P. 10
COASTAL PLANNING SERVICES, INC
.Kathy B. Vinson, AICP
Comprehensive Land Use Planning and Development Assistance.
P.O. Box 827 Office 252.354.4916'
Morehead City, NC 28557 Mobile [phone]
November 28, 2012
Mr. and Mrs. Myron Keith Maready
972 Van-Oert Drive
Winterville, NC 28590
Ire: 121 Hollings Court
Cannonsgate at 13ogue Sound
Dear Mr. and Mrs. Maready;
Royce L. 'Willoughby has retained Coastal Planning Services, Inc. to provide CAMA permitting assistance for the
above referenced property, The project site is also identified by Carteret County as Lot 485 Cannonsgate at Bogue
Sound. The property consists of Lot 485 and the westem half of the original Lot 484.
Mr. Willoughby has applied to Carteret County for a minor CAMA (Coastal Area Management Act) permit for
grading and placement of fill on the property and construction of a single-family residence with driveway,
swimming pool, and retaining wall to contain the fill. The permit request also includes decking and a fence around
the pool and walkways on the highground portion of the backyard. He, also plans to apply to the NC Division of
Coastal Management for a general CAMA permit for construction of a walkway over wetlands with an observation
deck or gazebo.
CAMA requires that adjacent riparian property owners be notified of the proposed work and that an opportunity be
provided to the neighbors to comment or object to the proposal. As the owner of adjacent riparian property we are
hereby notifying you of the proposed plans.
Enclosed with this letter are copies of the minor CAMA permit application and project drawings. Although no
action is required on your pert, it may expedite processing of the applications if you sign and return the enclosed "no
objection" fortes.
Please note that we are including two forms. The minor permit application with supporting documentation must be
submitted to Carteret County, while the general permit application for the walkway and observation platform will be
submitted to the NC Division of Coastal Management. If you wish to sign off on the projects, please be surd to sign
both forms and return to me. I have enclosed a stamped, addressed envelope for your use in returning these forms.
Again, no action on your part is required. However, for both permit applications no response from you is considered
the same as no objection.
If you have questions or comments about the proposed project or enclosed forms, pleaso feel free to contact me at
[phone], or by mail at the above address. You may also reach me at kbvin on ec.R.com

Dec. 3. 2012 3:59PM CARTERET CO WESTERN OFFICE No.2900 P. 11
Mr, and Mrs. Maready
November 28, 2012
Page 2
If you wish to file written comments or objections to this project with the Carteret County Minor Permit Program
YOU may submit them to:
Ms. Tracy Barnes
Local Permit Officer
Western Carteret County Planning &a Development
701 Cedar Point Boulevard
Cedar Point, NC 28584
Telephone: [phone]
If you wish to file written comments or objections to construction of the walkway and gazebo you may submit them
to:
Ms. Heather Styron
NC Division of Coastal Management
400 Commerce Avenue
Morehead City, NC 28557
Telephone: [phone]
Thank you for your assistance. .
Sincerely,
Kathy B. Vinson, AICP
Enclosures

Dec. 3. 2012 3:59PM CARTERET CO WESTERN OFFICE No. 2900- P. 12. '
CERTIFIED MAIL • RETURN RECEIPT REQUESTE('•
DIVISION:.OF COASTAL MANAGEMENT ?d 6V1 :o)
ADJACENT RIPARIAN PRUPERTY OWNER.NOTIFICATION101
Name of Property Owner: 44c4 e e �-- kJ;11&,944k h
Address of Property: % 1 lq(j /1:4g c C4 d u I'
(Lot or Street #, Siket or Road, City& County)
Agent's Name #: _5�h�-,/- 11,i7-re-n Mailing Address:
Agent's phone #, 7 kO6 r.,- h eQ(2�-- 6--A ,
I hereby certify. that I own property adjacent to the above referenced property. The individual
applying for this permit_has described to me as shown on -the attached drawing the development
they are proposing. A description or drawing. with dimensions;' must be provided with this letter.
i have no objections to this proposal. I have objections to this proposal.
Ifyau have objections to whatis being.proposed, you must. notify the Division of Coastal Management
(DCM)•in writing within 10 days: ofreceipt of this notice. Contact Information for DCM offices Is
available a# ww.nccoastalmana-rementnetleontact dcm.htm or by calling 1-8884RCOASr • No
response is considered the same *as no objection If you have been notified by Certified Mail,
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set
back a minimum distance of 15' from my area of riparian access unless waived by me. (if you
wish to waive the setback, you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Signatm •�—
��
Print or`f"ype Name
Mailing Address
C,tylstat
91I � -- 9e o
Telephone Number
(Adjacent Property Owner Information):
Signature
Print or Type Narne
Mailing Address
City/statelzip
Telephone Number
Date
Date
Rovi.earl fiHA 012

Dec. 1 2012 4:OOPM CARTERET CO WESTERN OFFICE No,2900 P. 13
� .. hu.k � �rf,,R,;,u;, -. CENT RIPARIAN PROPERTY. OWNER
�w4.Jc:; - I-EMENT FOR CAMA MINOR PERMITS
own property adjacent to /fie , WAd 4 a Li , is
(Name of Property Owner) r
NruNCrly rbcated at �� /T���' s C e u i 7� p . J e 14-12 C✓
U L%
Address, Lot, Block, Road, etc.)
on �? 0 Ll a 11 u 2 4 . in _/ll•!Gr/ O++r � . L 41 �^�'! cd7� �uH�i r�,w.C.
aterbody) (Tow and/or County)
He has•described to me as shown in the attached application and project drawing(s), the development
he is proposing at that location, and, I have no objections to his proposal.
(APPLICATION AND DRAWING OF PROPOSED DEVELOPMENT ATTACHED) . = - ; " 44 �
Signature
Print or Type Name
Telephone Number
Date

• -Dec. 3. 2012 4:OOPM CARTERET CO WESTERN OFFICE No.2900 P. 14
Postal
(Domesuc man onty; No t.nsuranca Coverage provided)
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