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HomeMy WebLinkAbout097-89_Porker, William F._19891205/ GENERAL INFORMATION 1. LANDOWNER Name w Ml EEC p 5 19a9 Address �D)Nev",, Y Cit S�/►S lrr .C. State Zip.StSLLLl_l_ Phone U6 2. AUTHORIZED AGENT Name Address 15L j' oy I �A�n Dr City cJici+aV f Gv �� State (� L. Zip 21 S Phone Si % • 3 6 3 T 3. LOCATION/DESCRIPTION OF PROJECT 4. AREAS OF ENVIRONMENTAL CONCERN (AEC) CLASSIFICATION (To be filled in by Local Per it Officer prior to completing application.) Ocean Hazard Estuarine Shoreline Other 5. PROPOSED USE Residential Commerical/Industrial Other 6. SIZE OF BUILDING IN SQUARE FEET: 151 X �� 7. SIZE OF SITE IN SQUARE FEET: 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. 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 sugges- tion to help you complete your project as quickly as possible. v This the ( day of Der- 1 9J?_7.. Applicant's s' azure (or aut orized agent) Indicate below address and phone if not shown above. 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: LOCALITY w • PERMIT NUMBER 0 q ?-"0 `7 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--a���� see Deed Book 12—t-u--, 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. 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 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) (2) T,,,_.. S►n� � �. I Z LerLcvrit (�cX SwatisbcNo (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 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 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 DeC , 194— Land owne o person aut rized to act as his agent for. purposes of filing a CA A application.