WO-06-15_Price, Burton_20150309

LocalityOn Permit Number
Ocean Hazard Estuarine Shoreline ORW Shoreline Public Trust Shorelir Other
(For official use only) I
GENERAL INFORMATION
LAND OWNER
Name: S_U2Td,J Phiee
Address: 126 ohlTe b'a.<- 1&04- 2bacdl
city: :5 ellA-- State: NC
AUTHORIZED AGENT
Name:r� �on eS
Address: PO ISb?CnP527
City: �r12AM'0t Ciry State: A) L
Zip: a $S8.2—
Zip: ASS?
Phone:
Phone: ?- - 726 - 3 9/8
LOCATION OF PROJECT: ( ddreswai
tr et name a d/or d' ect' s to sit . If not o can ont what is the game of the
adjacent waterbody.) (pO��(,1� — O
DESCRIPTION OF PROJECT: (List all proposed construction and land disturbance.) f�uT(>?ev✓L �1��t8�
OlL�FvVAv /
SIZE OF LOT/PARCEL: 144quare feet •66acres �Q�%7lli�lJJCW�lI
PROPOSED USE: Residential ❑ (Single-family ❑ Multi -family ❑) Commerical/Industrial ❑ Other
TOTAL ENCLOSED FLOOR AREA OF A BUILDING IN THE OCEAN HAZARD AREA OF
ENVIRONMENTAL CONCERN (AEC): square feet (includes all floors and roof covered decks)
SIZE OF BUILDING FOOTPRINT AND OTHER IMPERVIOUS OR.BVILT-11PON SURFACES IN THE
COASTAL SHORELINE AREA OF ENVIRONMENTAL CONCERN (AEC) ��quare feet (Calculations
includes the area of the roof/drip line of all buildings, driveways, covered decks, concrete or masonry patios, etc., that are
within the applicable AEC.)(Attach your calculations with the project. draw ing.)�
Choose the AEC area that applies to your property:
(1)within 75 feet of Normal High Water for the Estuarine Shoreline AEC
(2)within 575 feet of Normal High Water for the Estuarine Shoreline AEC, adjacent to Outstanding Resource Waters
(3)within 30 feet of the Public Trust Shoreline AEC
(Contact your Local Permit Officer if you are not sure which AEC applies to your property.)
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 NO P
If yes, list the total built upon area/impervious surface allowed for your lot or parcel. bb� square feet.

OTHER PERMITS MAY BE REQUIRED: The activity you are planning may require permits other than the CAMA minor development permit.
As a service we have compiled a listing of the kinds of permits that might be required. We suggest you check over the list with your I..PO to
determine if any of these apply to your project. Zoning, 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 Park Approval, Ilighway Connection, and others.
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 listed as landowner on this application has a significant interest in the real property described therein. This interest
can be described as: (check one)
Elan owner or record title, Title is vested in , see Deed Book
page in the County Registry of Deeds.
❑ an owner by virtue of inheritance. Applicant is an heir to the estate of ;
probate was in County.
Xif other interest, such
as written contract or lease, explain below or use a separate sheet and attach to this application.
G WUA I CC' A)%kA-490 R,.
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 a CAMA permit.
(Name) (Address)
t�) 11 8OA.) !�y While Ogee lVo lK (2bA4 � STe//A� C-
(2) ufard. PR04.jar 'as k> M OArC, �3lsd2oa,�, SnGC , A)C
(3)
(4)
FOR DEVELOPERS IN OCEAN HAZARD AND ESTUARINE HAZARD AREAS:
I 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 particular
hazard problems associated with this lot. This explanation was accompanied by recommendations concerning stabilization
and floodproofing 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 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 $100.00 made payable to the locality, and any
information as may be provided orally by the applicant. The details of the application 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 permit is subject to civil, criminal and administrative action.
This the P1 day of ) 6 , 2015
elc�_ A eo f—
ldowner`or person authorized to act as his agent
for purpose of filing a CAMA permit application

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ADJACENT RIPARIAN PROPERTY OWNER
STATEMENT FOR CAMA MINOR PERMITS
I hereby certify that I own property adjacent to B u2'%ati? Rec�5 is
(Name of Property Owner)
property located at 0AK 13/0Ff ROAQ ,
(Address, Lot, Block, Road, etc.)
on �A�Id 5�r DryK RItJ� , in ���c�- , N.C.
(Waterbody) (Town 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)
Signature
Print or Type Name
Telephone Number
Date

TA900I.10 T16 ACS Tax System
Parcel Inquiry
Parcel Number
R 5367.04.51.0075000
201�
Tax Codes District Code
2015 Taxpayer 52410
Twn / Sch 0015
BURTON DAVIS ETAL TREVIN PRICE
Spec Dist 40 19
1101 RIVER ROAD APT 4
User Codes
Deed Book/Page 1388 331 0781
00619
Plat Book/Page 21 88
GREENWOOD
MS 389304169
Property Addr: House# 126
Street Name WHITE OAK BLUFF
Alternate
More? �1
Street Type RD Dir Unit
CiStZp STELLA
NC 28582
Escrow
More? �
Legal Description
Plat
Other
More? N
Lot/Block
Deeded Acres .60
Previous 52410
More?
L9 SA WHITE OAK BLUFF
BURTON DAVIS ETAL TREVIN PRICE
Deed? Values?
,Y,
Delete ?
:Action ? „