08-0006_Dillard Wallace Constuction Co._20081020

FROM
(THU)JRN 29 2009 9:43/ST, 9:42/No.6807923747 P 1
`'Locality
Permit Number f.J
GENERAL INFORMATION
LAND
Name
Zip Phone<�.�
AUTHORIZED AGENT
Name _IQCLt
Address _ 7 15r •� t_ ;F m
City State
LOCATION OF PROJECT
(If not oceanfront, is waterbody natural or manmade?) hwxt& f .1`tLoL AIt,
DESCRIPTION OF PROJECT +�
AREAS OF ENVIRONMENTAL CONCERN (AEC) CLASSIFICATION
(To be filled in by the Local Permit Officer prior to completing application_)
Ocean Hazard Estuarine Shoreline ORW Shoreline Public Trust Shoreline Other
PROPOSED USE
—2L Residential Commerical/industrial Other
SQUARE FOOTAGE OF BUILDING FOOTPRINT AND OTHER IMPERVIOUS OR
BUILT -UPON SURFACES (such as driveways, etc.) within 75 feet of the esty,1,arine shoreline, or 575 feet of an
ORW shoreline, or 30 feet of the ublic trust sh re ne. �S � `�' XQ,5
SQUARE FOOTAGE OF TOTAL FLOOR A OF BUILDING Co �..5 S fe
SQUARE FOOTAGE OF SITE
OTHER, PERMITS MAY BE REQUIRED:
The activity you are planning may require
permits other than the LAMA 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 LPO to determine if
any of these apply to your project.
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 Horne Park Approval, Highway
Connection, and others.

FROM (THUNAN 29 2009 9:43/ST, 9:42/No.6807923747 P 2
I, the undersigned, an a plicant 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 d 4s:scribed*eone.)
ran owner or record titl Title is vested to , see Deed Sook6-i
page, in the County egistry o s. ee
an owner by virtue of inheritance. Applicant is an heir to the estate of ;
probate was in 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 NCMCE to each of them concerning my intent to develop this property and to apply for
a LAMA permit.
(Name) Address
(1)
(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 tome 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 1 am authorized to grant and do in fact grant permission to the local permit officer
and NS agents to enter on the aforementioned lands in connection with evaluating information related to this
permit application.
11is 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 thew;
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 g& day of QGf� 0 g 20
L6drov i ei onperson auW6-rized fo- act as his agent
for purposes of filing a CAMA pem-dt application.

cm
a
ti
v
ti
CV
rn
t-
00
CO
C>
Z
CV
­r
CDD
v
CT
CDD
C=:,
CV
cm
CV
z
x
0
I�
LEGE7� L+�Avr
EP = EJ05 ifNC IliOhf P1PF
EXfSIWO PC NAIL
mSCALE
kk
\
?Ms f'RG-M r AS LOCATED fN ZOC AE AM7 1S
AV SPFLTAL fLOGO HAZAM AREA ASaTFUMV 8Y
RATE MAPS
PLorr#G f
SCA[!VC AND CNAAfGC RfW N.FLP.
370418-6444-J
EPK =
EN EXISANG NAIL `
OA707-2-04 LW46TYPANfI
STATE qF NW79 CAAaJVA
-
EX1 STAKE
N+P a NEW IRON �G
S!
Lb[AITY OF PAiE�f00
0 owrING Er
war �lp
_
REWEW OFF CD? CF PAI&W cawT7;
CfRMY THAT WMV OR PLAT iO
%►� � Rrc�rrro� WA
£ = CE7J7ERLJNE O90
NOT rO SICALE
rMEi1y� �Pr
1\\
Mffof Tlfr'S caw]C.4T10W IS AFFAW
iUM Ail SiAi M?y ft-a WMWFS
PP - PON£R POLE ♦ \ MCMffAMP
--E— = owMEAD ELEM ICAL d'p,
FEWLIE
7 f REf1A4(tTAfx
YOF - WOOD
OF a HIRE
SN7t7Gi4Y
OitET11UIMG
RE11EN' 07M
.9'f]fNC
Ep - EDGE OF PAWMENT
Sry �� MVEM TOP
60 R
�
SL
- -
vw s7'1M
ccphs??1 a8i
PP 58T
-~J_
-^13
� _Ns19
Aa
- - 32.33
E
--, -
i
FP1f �4
g5 �
37. f6'
t
o, ad
A' TO 'A' ALOVG
.
Ea0 nw so' EASF]IENT 9i �Z5l
A N o F
A 6'5:WOO'iv
DC5
W 5130'
31.71Dy .
7N652
R
fp
so' R1W FA r
P )
STATE OF AWN erwnLM LDYW 610 wr
a M.
f4.47' sift' IAJXo
^
� pJa
WYAW
'
R. AfOOff //
g f M DAHM ryPE CERI Y PMT M
PLAT WS DRAMN LOWAfY SW RMSa►l FAUBf AN ACT"
0t .�
2SY5d
w = P 4a
SLWWr AW iAi ItY SIDE M : T1MT i
Cr FIN- fGMl AS CAL(3.k+iED IS I.-M is
MS PAM4W A AL7 UW M I WN
AS AfA:A M HI ETS My MW
-
3
MAIM AW 5FA! T}A4 DAr �
8
SEAL
z r
QAf126A DATA
NLzdm IrALUCT
..
8
t
��arx a tnrxrarp �ausr s, ,aaor
r
r,� P.A
4s, so'
A'SSTb�B'fV IRY70
�w��
Alm" QV"7 AUVW 41"M
fn
ZOO
1f BY: Rau.
SaRX Cis- RRF `w�
' 0
A 7t7.i: lw DSO/
SCAii : T 30'
De J07, P 42 u�� NOSE RIWR ,, �
Phu"(�) 5�' -& pRaL
NO 0"43
LIB JBJ, P 4w
AB fb8, P A63�w�hJ
LaRAFM -WALE
JP�' j258� S�Z Ol.RF
a7 fF : 8-a-o7
e