WO-02-07_Land, Larry and Horton, David_20061227

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GENERAL INFORMATION
LAND OWNER
Name J�
Address 9
city
AUTHORIZED AGENT
Name XI of
Address
Q7
LOCATION Of
the adjacent waterbody?)
State Zip .. Phone
PROJECT: (List all
I. %,f
name and/or directions to site. If not oceanfront, what is the name of
r�
and land d urbancc.)
_.
SIZE OF LOT/PARCEL: square feet - W acres
PROPOSED USE: Res.idcntial !Z (Single-family 1Z Multi -family ) Comme.rical/Industrial
Other
TOTAL ENCLOSED FLOOR AREA Of AB DING IN TFIE OCEAN HAZARD AREA, OF ENVI-
RONMENTAL CONCERN (AEC): square feet (includes all (loots and roof -covered decks)
SIZE OF BUILDING FOOTPRINT ,AND OTHER IMPEMOUS OR BUILT -UPON SIN
THE COASTAL SHORELINE AREA OF ENVIRONMENTAL CONCERN (AEC): W 71�sq. ft.
(Calculations include the area of the roof/drip lute of all buildings, driveways, covered decks, co Crete or masonry patios,
ctc. that are within the applicable AEC. Attacks your calculations with the project dray ing.),p�� rf 9►�
Choose the AEC axes that applies to your property: /a
(1) within 75 feet of Normal High Water for the Estuarine Shoreline AEC
(2) within 575 fcet of Normal High. Water for the Estuarine Shoreline AEC, adjacent to Outstanding
Rcsouree Waters
( )' within 30 feet of the Public Trust Shoreline .AEC
(Contact your Local Permit Officcr if you arc not sure which AE,C applies to your property.)
-5TAi'E STOR11IWATER MANAGEMUff PERfi11M.'is the project located in an area subject ro a
S-SetortawatiManagennen Permit issued by the N.C. Division of Water. Quality?
YES- NO -
If yes, list the total built-ul
;surface allowed for your lot or parcel. square feet.

05/07/2007 10:40 3933205 WESTERN OFF PAGE 06
ITHER PERMI'li'S MYBE REQUIRED: The activity you arc planning may require permits other than the CAMA minor
:velopment permit. As a servi.cc we have compiled a list of the kinds of permits that might be required. We suggest you check over the list
irh your LPO to determine if any of these apply to your project_ Zoning, Drinking Water Wcll, Scpticlank (or othersanirarywaste
eatmentsystem), Bading, Electrical, Plumbing, Hentiog and Air Conditioning, Insulation and Energy Consetvzdon, FIA Certification,
tnd Dune, Sedimenr Control. Subdivision Approval, Mobilc Horne ParkA.pproval, Highway, Connection, and others.
4
TA.TEMENT OF OWNERSHIP:
the undersigned, an applicant for a CAMA, minor development permit, being either the owner of property in an AEC or a
=on authorized to act as an agent for purposes of applying for a C,A..MA. minor development permit, certify that the person
;ted as landowner on. this application has a significant interest in the real property described therein. This interest can be
ncrribcd as: (check one)
Zan owner or record ride. Title is vested in �Cou
�j �rl?da_sce Decd Boole
e in the tegnst�'
of Deg
,_.,an owner by virtue of inheritance. Applicant is an heir to the estate of
.obatc was in County.
,.,,.,if uther interest, such as written contract or lease, explain below or use a separate sheet and attach to this application.
ionnCATION OF ADJACENT PROPERTY OWNERS:
Furthermore certify that the following persons are owners of properties adjoining this property. I affirm chat I have given
CTUAL NOTICE to eacl, of them concerning my intent to develop this property, and to apply for a LAMA permit..
i�
F�
OR DEVELOPERS IN OCEAN HAZARD AND ESTUARINE- MAZARDAREAS:
ic1mowlcdgc that the land owner is aware that the proposed dtrvclopmemt is planned for an area which may be susceptible to
)lion and/or flooding. I acknowledge that the local permit officer has explained to me the particular hazard problems associ-
A with. this lot. This explanation was accompanied by recommendations concerning stabilization and floodproofing tech-
ques.
ERMISSION TO ENTER ON LAND:
iutbermorc certify that I gun authorized to grans and do in fact grant permission to the local permit officer and his agents to
ter on the aforementioned lands in connection wirh evaluating information related to this permit application.
►is application includes. general information (this form.), a site drawing as described on the back of this application, the
mcrship statement, the AEC hazard notice where necessary, a check for $100.00 made .payable to the locality, and any infor-
uion as may be provided orally by the applicant. The details of the application as described by these sources are incorporated
thour, reference in any permit which may be issued. Deviation from these details will constitute a violation of any permit Any
rson developing in an AEC without permit is subject to civil, criminal and adt iinistrative action.
This the of , 20 "
Landowner or person authorized to act as his agent r purpose of filing a LAMA permit application.

05/07/2007 10:40 3933205 WESTERN OFF PAGE 07
SITE DRAWING/APPLICATION CHECKLIST
lease make sure your site drawing includes the following information required for a CAMA minor development
ermit. The drawing may be simple and not necessarily to scale. The Local Permit Officer will help you: if
:quested.
HYSICAL DEVIENSIONS
Label roads
Label highways right-of-ways
_ Label local setback lines
Label any and all structures and driveways currently existing on property
MYSICAL CHARACTERISTICS
Draw and label mean high water .marls
Draw location of on -site wastewater system
you. w-ill be working in the ocean hazard area:
Draw and label dune ridges (note height)
Drams+ and label toe of dune
ldentify and locate first line of stable vegetation
Draw and label setback line under LAMA
Draw and label topographical features (optional.)
you will be working in an estuarine shoreline area:
Draw and label landward limit of AEC
Describe terrain (slope)
)EVIELOPMENT PLANS
Draw and label areas that will be disturbed
If a house is to be placed on lot, describe location of house
Note size of piling and depth to be placed in ground
Draw and label all areas to be paved or graveled
Describe composition of surface
Note and list fully all trees and vegetation to be removed or relocated
Show landscaping
TOTE TO APPLICANT
lave you:
• completed A blanks and / or indicated if not applicable?
• notified and listed adjacent property owners?
• included your, site drawing/
• signed both application and statement of ownership?
• enclosed the $100.00 fee?
• completed an .AEC Hazard Notice, if necessary?
Site Notice Posted
Site Inspections
Date of Action: Issued
.Revised 3/2003
FOR STAFF USE
Final Inspection Pee Received
Exempted Denied Appeal Deadline (20 days)