Not Given_Gore, Leo_19970923

Locality
GENERAL INFORMATION
� Number
:z
rSE2 *9 19_
LAND OWNERr -----
Name 1- ce
Address 32 <4 5��R POIlk-T Bld-wl•
City s ill /�S1�C� t��0 State Al, L� Zip 2 ! urSg 4 Phone 9/,7
AUTHORIZED AGENT
Name
Address
City _
State Zip
Phone
LOCATION OF PROJECT ,3.3 �Z , 611V 7 ffIVol
19 /yz) 06 shy Si
(If not oceanfront, is waterbody natural or manmade?)
DESCRIPTION OF PROJECT�I •,•"- /G:.t.d scc�o�! !�ty �0 3 �/ �ea�., rRc5��✓l,C�j�lr:
—r- /ace 29 'IX y�' �1 b1�.= `iQm� .�,v IIL�'ca r, l3uMA,—,xg
AREAS OF ENVIRONMENTAL CONCERN (AEC) CLASSIFICATION
(To be filled in by the Local Permit Officer prior to completing application.)
k \ .
Ocean Hazard v Estuarine Shoreline ORW Shoreline Other
PROPOSED USE
V Residential Commercial/Industrial Other
SIZE OF BUILDING IN SQUARE FEET 4 3 VX
Size of other impervious orb t upon surfaces (such as driveways, etc.) within 75 feet of the shoreline (575 feet
of an ORW shoreline) ,A714 <,n
SIZE OF SITE IN SQUARE FEET
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 com-
plied 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 LAMA, only a sugges-
tion to help you complete your project as quickly as
possible.
Zoning, Drinking Water Well, Septic Tank (or other
sanitary waste treatment system), Burning, Electri-
cal, Plumbing, Heating and Air Conditioning, In-
sulation and Energy Conservation, FIA Certifica-
tion, Sand Dune, Sediment Control, Subdivision
Approval, Mobile Home Park Approval, Highway
Connection, Others:

Locality
Permit Number
GENERAL INFORMATION
LAND OWNERy
Name croj?'E
Address .3 3! V- ,0011 E Z71�.
City G o State Al, Z:f zip 2.Trsgq Phone
AUTHORIZED AGENT
Name
Address
City
State Zin
Phone
LOCATION OF PROJECT ,33 c�'�,�,� r01'-V T-
LIB it l i'1
(If not oceanfront, is waterbody natural or manmade?)
DESCRIPTION OF PROJECT
AREAS OF ENVIRONMENTAL CONCERN (AEC) CLASSIFICATION
(To be filled in by the koZcal Permit Officer prior to completing application.)
Oc
c/
ean Hazard Estuarine Shoreline ORW Shoreline Other
- 3 93
PROPOSED USE
Residential Commercial Industrial Other
SIZE OF BUILDING IN SQUARE FEET / JVV
Size of other impervious or bu' t upon surfaces (such as driveways, etc.) within 75 feet of the shoreline
of an ORW shoreline) h,e 2tsg ��l
SIZE OF SITE IN SQUARE FEET
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 com-
plied a listing of the kinds of permits which might
uired. We list th your Local suggest
ermit Ofat ficer o determinu check over es
Which, if any, of these may apply to your project.
4 ..This is not a requirement of LAMA, only a sugges-
{ A lion to help you complete your project as quickly as
possible.
Zoning, Drinking Water Well, Septic Tank (oroth
sanitary waste treatment system), Burning, Elects
cal, Plumbing, Heating and Air Conditioning, Irr
sulation and Energy Conservation, FIA Certifica
tion, Sand Dune, Sediment Control, Subdivision
Approval, Mobile Home Park Approval, Highwa;
Connection, Others:

A
STATEMENT OF OWNERSHIP.
I, the undersigned, an applicant for a CAMA minor development permit, begin 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 sig-
nificant interest in the real property described therein. This interest can be described as follows: (check one)
man owner of record title, Ti e isMeited�in�* 1.. � if f� jZsee Deed Book VD 3
page /33 in the nty Registry of Deeds.
an owner b f inheritance. Applicant is an heir to the est to 0
probate ��ra�;n County.
if other interest, such as written contact or lease, explain below or use a separate sheet and attach 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)
(1) y1/ILL1XA11 A
(2)
(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 ap-
plication, the ownership statement, the AEC hazard notice where necessary, a check for $50.00 made payable to
the locality, and any information as may be provided orally by the applicant. The det sai�Tapplication 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 per-
mit is subject to civil, criminal and administrative action.
This the 2.3 day of 44b %' ,19 17.
Land owner or -person authorized to act as his agent
for purposes of filing a CAMA permit application.
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