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Local Government Permit Number
CAMA
MINOR DEVELOPMENT
PERMIT ► �r-
as authorized by the State of North Carolina, Department of Environment,
Health, and Natural Resources and the Coastal Resources Commission for development
in an area of environmental concern pursuant to Sedion 113A-118 of the
�Q General Statutes, "Co al Ar Man em�nt "
Issued to l./ autl�rizing develop_m_en-tin,
at `J2 KC1 fi (W !� i . "` APAQ t�JO
as requested in the permittee's application, dated _ ILA "L ► 1 t AN .
This permit, Issued on 2 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 those terms may subject
permittee to a fine, imprisonment or civil action, or may cause the permit to be null and void.
1. All proposed development and associated construction must be done In accordance with
the permitted workplat drawing (s) as originally submitted.
2. All construction must conform to the North Carolina Building Code requirements and all
other Local, State and Federal 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. In order to prevent sedimentation, a vegetated buffer zone must be maintained between
all disturbed area and the adjacent waterbody or marsh
5. Prior to initiating any land -disturbing activities, a barrier line of filter cloth, staked hay
bales, or burlap 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
vegetated cover.
6. Pursuant to 15 NCAC, Subchapter 7J.0406(b), this permit may not be assigned,
transferred, sold or otherwise disposed of to a third -party.
7. The area proposed for grading within the 30' buffer from the normal high water
contour/normal water contour must immediately be vegetatively stabilized, and must
remain in a vegetated state.
8. No excavation or filling of any wetlands or waters is authorized under this pertnit.
9. Property to be graded to allow all water run-off to the inland side of property. No water
run-off is permitted to the waterway.
10. A copy of this permit shall be available onsite for regulatory inspection.
This permit action may be appealed by the permittee or other
qualified persons within twenty (20) days of the issuing date.
From the date of an appeal, any work conducted under this per-
mit must cease until 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 modifications not covered
under this permit requires further written permit approval.
All M� ass when this permit expires on December
31,
In issuing this permit it is agreed that 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 written approval of the Division of Coastal Management.
F . Local Permit Officer (signature)
name
-ly l Cedar Pola-lbwa .
address
CedarP014, nc 215��
Permittee
(signaturrequired if special conditions above apply to permit)
01/11/2005 12:07 3933205 WESTERN OFF PAGE 06
GENERAL nWORMAnON
zip ' 8 , %fa
ALITHORUM AGENT
Name /
Address _.
State
OF PROJECT (Address, street name and/or directions to site. If not octanliont,
the adjacent waterbody?)
DESCRIPTION OF PROJECT (List all proposed construction and land distarbance.) _, Cya�+sTrN
l�ao d&�.! t.1 A II .3 All, O � -4 .a'� ,ram cl . v
SrM OF LOT/PARCEL: a 0 �° `'''� square Feet % _ acres
PROPOSED USE: Residential ✓ (Single-family Z" Muld-family ) Commerical/Industrial
TOTAL ENCLOSED FLOOR AREA OF A BUILDING IN THE OCEAN HAZARD AREA OF EN q-
RONMENTAI. CONCERN (AEC): square feet (includes all floors and roof -covered decks)
SIZE OF BUILDING FOOTPRINT AND OTHER RWP'ERVIOUS OR BU]'X UPON SURFACES:IN
THE COASTAL SHORELINE AREA OF ENVIRONMRTrAL CONCERN (AEC): sq. ft.
(Calculations include the area of the roof/drip line of all buildings, driveways, covered decks, concrete or masonry patios,
em that arc within the applicable AEC. Attach your calculations with the project drawing.)
Choose the AEC area that applies to your property:
O 'thin 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
(3) within 30 feet of the Public Trust Shoreline AI�V
(Contact your Local Permit Officer if you are not sure which AEC applies to your property.)
STATE S'TORMWATER MANAGEMENT PERMIT: is the project located in an area subject to a
State Stormwater Management Permit issued by the N.C. Division of Water Quality?
YES NO_ A
If yes, list the total built -upon area/impervious suriacc allowed .for your lot or parcel. Square feet.
L
01/11/2005 12:07 3933205
WESTERN OFF
PAGE 09
OTMR PERMITrS MAX BE REQLTDtEDa The activity you arc planning may requite permits other than the CAMA minor
development permit. As a service we have compiled a list of the lends of permits that might be required. We suggest you check over the list
with your LPO to determine if aoy of these apply to Your project: Zoning, Drinking Vater'PcU- SepticTsnk (ot other s"try *aces=
ecatmeun system), Building, Mcctsical. Plumbing, Hewing aced Air Con d Conservation, FIA Ccruficanon,
Sand Dune, Sediment Control, subdivision Approval, Mobile Home ParkApp i roval, y , Co pSy ,�.Y.�..% Yyf
STAMBONT
�Cr
OF 0VNERSB3P: OCT 2 9 an ►d
1, the undecsipcd, an applicant for a CAMA minor dcvclopment permit, being either the o mer of property in an AEC or a
n authorized to act as an agent for purposes of applying for a CAMA minor c . �r ie Don
Pam° do ="Xd therein. This inti nst can
listed as landowner on this application has a significant interest in dac real property
c6cxibcd as: (check one)
an owner or record tide. Tide is vested iur
ace Deed Book Ipal �
_:S -- in the ' : / M : County Registry of Docdt.
an awrier by virtue of inheritanot: Applicant is an heir to the =ante of
probate was in CO`rntyI
lain below or use a tc sheer and attach to this application.
jfvther interest, such as written contractor lease, e�tp �Pu'
NOTMCAnON OF ADJACENT PROPFKff OWNERS:
J furthermore certify that the Mowing persons are owners of properties adjoining this property. I affirm that I have given
ACTUAL NOTICE to cacti of them concerning my intent to develop this property and to apply for a CAMA permit.
(Namc) (Address) s 0
+J 16kr
(2) gS
(3)
(4)
FOR DEVELOPERS IN OCEAN HAND AND ESMARIM HAZARD AREAS:
I acknovvl«lge that flit land owner is aware that the proposed development is planned for on 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 associ-
ated with this lot. This explanation was acconapanled by recommendations concerning stabilization and floodproofing tech-
niqucs.
PERMSSION TO ENTER ON LAND:
I furthermore certify that I am authorized to grant and do. in fact granrpermission to the local permit officer and his agents to
enter on the aforementioned lands in connection with evaluating information related to this permit application.
Ibis application includes: gener+l 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 infor-
mation as may be provided orally by the applicant The details of the application as described by these sources art inc Orpo Attd
a Any
permit without reference in any which may be issued. Deviation from these details will constitute a violation of any perm
person developing in an ABC without permit is subject to civil, criminal and administrative action.
zluis a day of
fP'• fit'
Landowner or person authorized to act as his agent for purpose of filing 2 CAMA permit application.
4
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01/11/2005 12:07
3933205 WESTERN OFF
PAGE 08
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