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HomeMy WebLinkAbout27-06_Town of Pine Knoll Shores_20061220DCM/MHD #27-06 Local Government Permit Number CAMA MINOR DEVELOPMENT PERMIT as authorized by the State of North Carolina, Department of Environment, and Natural Resources and the Coastal Resources Commission for development in an area of environment concern pursuant to Section 113A-118 of the General Statutes, "Coastal Area Management" Issued' to the Town of Pine Knoll Shores, authorizing development in the Codstal Shoreline (AEC) at 347 Salter Path' Road, in Pine Knoll Shores, Carteret County as requested in- the permittee's application, dated received November 14, 2006.. This permit, issued on December 20, 2006,. 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 these terms may subject permittee to a fine, imprisonment or civil action, or may cause the permit to be null and void. This permit authorizes the installation of a stormwater infiltration system. (1) All proposed development and associated construction must be done in accordance with the permitted work plat drawing dated received on November 14, 2006. (2) All construction must conform to the N.C. Building Code requirements and all other local, State and Federal regulations, applicable local ordinances and FEMA Flood 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) A copy of this permit shall be posted or available on site. Contact this office at (252) 808-2808 for a final inspection at completion of work. (Additional Permit Conditions on Page 2) 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 permit 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 modification not covered under this permit, require further written permit approval. All work must cease when this permit expires on December 31, 2009 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. (Insert LPO Name) r:anaG I nnal Permit Offici I Stephen Lane, DCM Fir d Rep. 400 Commeree Avenue Morehead Cit , N" 28557 Telq (252)1 2808 Permittee (signature required if conditpns ab96e apply to permit) Name: Town of Pine Knoll Shores Minor Permit # _ 27 _06 Date: 12/20/06 - (5) Pursuant to 15A NCAC, Subchapter 7J.0406(b), this permit may not be assigned, transferred, sold or otherwise - disposed of to a third -party. (6) The structure must. set back a minimum of 60 feet from the first line of stable vegetation, as determined by the DCM. (7) Any structure authorized -by this permit shall be relocated or dismantled when it becomes imminently -threatened by changes in shoreline configuration. The structure(s) shall be relocated or dismantled within two years of the time when it becomes imminently threatened, and in any case upon its collapse or subsidence. However, if natural shoreline recovery,or beach renourishment takes place within two years of the time the structure becomes imminently threatened, so that the structure is no longer imminently threatened, then it need not be relocated or dismantled at that time. This condition.shall not affect the permit holder's right to seek authorization of temporary protective measures allowed under CRC rules. (8) All unconsolidated material resulting from associated -grading and landscaping shall be retained on site by effective sedimentation and erosion control measures. Prior to any land -disturbing activities, a barrier line of filter cloth must be installed between the land disturbing activity and the adjacent water areas, until such time as the area has been properly stabilized. i Signature Date S 6 DCM/MHD #27-06 Local Government Permit Number CAMA MINOR DEVELOPMENT PERMIT as authorized by the State of North Carolina, Department of Environment, and Natural Resources and the Coastal Resources Commission for development in an area of environment concern pursuant to Section 113A-118 of the General Statutes, "Coastal Area Management" Issued' to. the Town of Pine Knoll Shores, authorizing ,development in the Coastal Shoreline (AEC) at 347 Salter Path Road, in Pine Knoll Shores, Carteret County as requested in the permittee's application, dated received November 14, 2006, This permit, issued on.December 20, 2006, 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 these terms may subject permittee to a fine, imprisonment or civil action, or may cause the permit to be null and void. This permit authorizes the installation of a stormwater'infiltration system. (1) All proposed development and associated construction must be done in accordance with the permitted work plat drawing dated received on November 14, 2006. (2) All construction must conform to the N.C. Building Code requirements and all* other local, State and Federal regulations, applicable local ordinances and FEMA Flood 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) A copy of this permit shall be posted or available on site. Contact this office at (252) 808-2808 for a final inspection at completion of work.. (Additional Permit Conditions on Page 2) 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 permit 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 modification not covered under this permit, require further written permit approval. All work must cease when this permit expires on December 31, 2009 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. (Insert LPO Name), rcnen i Mai Parmit 01fici I ,Stephen Lane, DCM Firld Rep. 400'Commeree Avenue Morehead City, N.C. 28557 Tele: (252)808-2808 Permittee (signature required if conditions above apply to permit) Name: Town of Pine Knoll Shores Minor Permit # _ 27 _06 Date: 12/20/06 (5) Pursuant to 15A NCAC, Subchapter 7J.0.406(b), this permit may not be assigned, transferred, sold or otherwise disposed of to a third -party. (6) The structure must set back a minimum of 60 feet from the first line of stable vegetation, as determined by the DCM: (7) Any structure authorized by this permit shall be relocated of dismantled when it becomes imminently threatened by changes in shoreline configuration. The structure(s) shall be. relocated or dismantled within two years of the time when it becomes imminently threatened, and in any case upon its collapse or subsidence. However, if natural shoreline recovery or beach renourishment takes place within two years of the time the structure becomes imminently threatened, so that the structure is no longer imminently threatened, then it need not be relocated or dismantled at that time. This condition shall not affect the permit holder's right to seek authorization of temporary protective measures allowed under CRC rules. (8) All unconsolidated material resulting from associated grading and landscaping shall be retained on site by effective sedimentation and erosion control measures. Prior to any land -disturbing activities, a barrier line.of filter cloth must be installed between the land disturbing activity and the adjacent water areas, until such time as the area has been properly stabilized. Signature Date i f 1 Y Y I rs of C0 APPLICATION FOR CANU MINO I� DE LO PIT . -PRPRmIT In 1974, the North Carolina General Assembly passed the Coastal Area Management Act and set the stage for guiding°development in fragile z ; and productive areas that border the state's sounds and 'oceanfront. Along !with requiring special care by those who build and develop, the General Assembly directed the Coastal Resources Commission (CRC) to imple- ment clear regulations that minimize the burden on the applicant. This application fora minor development permit under CAMA is part . effort meet the spirit � of the Commissions•; e pit and intent of the General Assembly. It has be - _ been desi ned to be.straightforward and require no g F w k more time or ont effort' necessary frthe, applicant. Please go over this i folder with the Local Permit fficer LP for l O ( O) o the locality m which you plan to build to be certain that you understand whatinformation he 'or r=-- she needs. 1' i Under.CAMA regulations, the minor permit is,,to be issued.within 25 = ��' 'dais once a complete application is in hand: Often less time is needed if �. ;the project is simple'. The process generally takes about 18 days. You can, speed the approval process bymaking certain that your application } ` is complete and signed, -that your drawing meets the specifications given , inside and that your application fee is attached. - Other permits are sometimes required for development inthecoastal area. While these are not CAMA-related, we urge you to check with the 'Local Permit Officer to determine which of-theseyou may need. A listing is included on page 2 of this folder. We PP. - a reciate your cooperation with the North Carolina Coastal Man- ' agement Program and your willingness to build in a way that protects the resources of our beautiful and productive coast. f- Coastal Resources Commission Division of Coastal Management } al a: Locality Permit Number Ocean Hazard Estuarine Shoreline ORW Shoreline Public Trust Shoreline Other (For official;use-only),,fl {'tom n � t `a -�, F•� z GENERAL INFORMATION NOV 1 4 2006 LAND OW 4ER Name own OF Pme, kvol) Shatter iVi �' h? iy Df Address IDQ JY1m:n1 C-1 D&J City `1State Zip 4_�AS Z Phone2,e>Z.' 2L1,1 AUTHORIZED AGENT Name Address City _ State Zip Phone LOCATION OF PROJECT: (Address, street name and/or directions to site. If not oceanfront, what is the name of the adjacent waterbody?) 3L7 R-A. C U-0,n SAGAny-P, 1 ."lt C. DESCRIPTION OF PROJECT: (List all proposed construction and land disturbance.)i'14�tti 4��o?,w,w&6n. LYNVrAk- . or sUs�- SIZE OF LOT/PARCEL: 10D s, 3 S$• square feet AR • 1. acres PROPOSED USE: Residential (Single-family Multi -family ) Commerical/Industrial Other TOTAL ENCLOSED FLOOR AREA OF A BUILDING IN THE OCEAN HAZARD AREA OF ENVI- RONMENTAL CONCERN (AEC): N A- square feet (includes all floors and roof -covered decks) SIZE OF BUILDING FOOTPRINT AND OTHER IMPERVIOUS OR BUILT -UPON SURFACES IN THE COASTAL SHORELINE AREA OF ENVIRONMENTAL CONCERN (AEC): 14A sq. ft. (Calculations include the area of the roof/drip line of all buildings, driveways, covered decks, concrete or masonry patios, etc. that are within the applicable AEC. Attach your calculations with the project drawing.) Choose the AEC area that applies to your property. (1) within 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 Resource Waters (3) within 30 feet of the Public Trust Shoreline AEC (Contact your Local Permit Officer if you are not sure which AEC applies to your property.) STATE STORMWATER 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 If yes, list the total built -upon area/impervious surface allowed for your lot or parcel. % U square feet. NCDENR North Carolina Department of Environment and Natural Resources Division of Coastal Management Michael F. Easley, Governor Charles S. Jones, Director William G. Ross Jr., Secretary December 8, 2006 Town of Pine Knoll Shores Attention:.Mr. Chris Jones 100 Municipal Circle Pine Krioll'Shores, NC 28512 RE: NOTICE TO EXTEND TIME TO GRANT OR DENY CAMA PERMIT (MINOR) AT 347 SALTER PATH ROAD Dear Mr. Jones: Pursuant to NCGS 113A-121(b), the undersigned hereby gives notice to applicant that for a good cause, and in order to properly consider all 'information necessary to making a decision on this permit application, the time period within which a final decision shall be made has been extended an additional twenty-five (25) days. Sincerely, Stephen Lane Coastal Management Representative 400 Commerce Avenue, Morehead City, North Carolina 28557 Phone: 252-808-2808 \ FAX: 252-247-3330 \ Internet: www.nccoastalmanagement.net An Equal Opportunity \ Affirmative Action Employer — 50% Recycled \ 10% Post Consumer Paper NCDENR North Carolina Department of Environment and Natural Resources Division of Coastal Management Michael F. Easley, Governor Charles S. Jones, Director William G: Ross Jr., Secretary November 21, 2006 Carteret New Times Legal Advertisement Section Fax: 252-726-2653 Re: Public Notice - Town of Pine Knoll Shores Dear Sir: Please publish the attached Notice in the Viednesday, NovemberX, 2006, issue of the Carteret News Times. The State Office of Budget and Management requires an original Affidavit of Publication prior to payment for newspaper advertising. Please send the affidavit, an original copy of the published notice, and an original invoice to Dale Schmidt, NC Division of Coastal Management, 400 Commerce Avenue, Morehead City, N.C. 28557, Telephone (252) 808-2808. Thank you for your assistance in this matter. If you should have any questions, please contact me at our Morehead City office (252) 808-2808. Sincerely, Stephen Lane Coastal Management Representative Enclosure cc: Tere Barrett - District Manager 400 Commerce Avenue, Morehead City, North Carolina 28557 Phone: 252-808-28081 FAX: 252-247-33301 Internet: www.nccoastaimanagement.net An Equal Opportunity 1 Affirmative Action Employer — 50% Recycled 110% Post Consumer Paper NOTICE OF FILING OF APPLICATION FOR CAMA MINOR DEVELOPMENT PERMIT Notice is hereby given that the Town of Pine Knoll Shores has applied to the Department of Environment and Natural Resources for a Minor Development permit. The applicant is requesting to install a Stormwater Infiltration System at 347 Salter Path Rd., adjacent the Atlantic Ocean, in Carteret County, North Carolina. Persons desiring to inspect the application, or to comment thereon, are directed to contact Stephen Lane, NC Division of Coastal Management, 400 Commerce Avenue, Morehead City, NC, Telephone (252) 808-2808, no later than November 30, 2006. Comments received prior to that date will be considered in making the permit decision. Later comments will be accepted and considered up to the time of permit decision. Project modifications may occur based on further review and comments. Notice of the permit decision in this matter will be provided upon written request. F'1J-Y 3.14 PLEASE PUBLISH ON: , November�2; 2006 P. 01 TRANSACTION REPORT NOV-21-2006 TUE 10:10 AM DATE START ' RECEIVER TX TIME PAGES TYPE NOTE M# DP NOV-21 10:08 AM 97262653 39" 2 SEND OK 977 - fY8°•1t?Il'Ar.3f.'it9(BRIU•,iC(iJ'.4rlY rairi.tP Nql t1-I ,i nll pll Y. k('ra.+v tF�l TOWN OF PINE KNOLL SHORES 100 Municipal Circlo Pine Knoll Shores, NC 28512 252-247-4353 11/10/2006 4409G $1.00.()0 'AY ****100 DOLLARS AND 00 CENTS **kk w IE CAMA R 400 COMMERCE AVE. MOREHEAD CITY, NC 28557 11404L,09611' II liS I71.^.1)Ui:,;i Jr.IJi HAS ULF14 J; 91`kTJ� GJ.S Ia:()UGk(; Fly ��T k LUC)11.G�bkl)(?•AktJTI.tIJlll'11.J ld9r)!'I:i/C'lJ GONIPOLMT. 1:0 5 3 100 3001: 13 h 50 U1 LO 1311" S gg� :E o C fl(I ,i EMER61ENC I 11E iUE ACLESS UMP Flv.sz L%JAS o ff 5PRia -V A o s-r uvh t_ v "ZT—A- ov% HWV 58 �x1sTl �� PARKIN&- `�b'pC�ED �ToRI�nWA�I'�� �._�Gol1�-ion 1`tTLE7� �wld t • Wonp � d-StloklER -MV F,zEa l os Caw sh6p c-- LN LoT ! kAY kEW)NC7 A c�1 ` �c�yT1HG� %Z 6-sl' rooms I nq D' m sh0CE LN R�? Nt WM7 -D,97yE► L-6 -7 C)w 1\1 b F l FINE maw skrE s S lT1r PLAN �,uIK Ern -Dy-h N 13�rC,.�c�uES 5C�1 Z5 • Duo �S Ow W ror 4 .1 tip.+� ■ Complete items 1, 2, and 3, Also complete...,. * item 4 If Restricted Delivery is desired. c ■ Print your name and address on the reverse so that we can return the card to you. ■ Attach this card to the back of the mailpiece, or on the front if space permits. 1. Article Addressed to: R,Tp A r+. 16,,Jeopmefik /3 /1`rlVe- �5-'0 A. Signature ;X 4,!►9 ❑ Addressee B. Received by (Printed Name) C. Date of Delivery D. Is delivery address different from Item 1? ❑ Yes 11 YES, enter delivery address below: 0 No 3. 1-*0 Certified Mail O Express Mail tM"fiegistered ❑ Return Receipt for Merchandise 0 Insured Mail O C.O.D. 4. Restricted Delivery?ffxtm Fee) 2. ArticleNumber (Transfer "7 / )� O from label m service kW / !/ PS Form 3811, February 2004 Domestic Return Receipt 0 Yes 102595-024A-1540 UNITED STATES POSTAL SERVICE First -Class Mail Postage & Fees Paid USPS Permit No. G-10 • Sender: Please print your name, address, and ZIP+4 in this box • TOWN Cf PINE KNOLL SHORES 100 Municipal Circle Pine Knoll Shores, NC 28512 THE TOWN OF PINE KNOLL SHORES 100 Municipal Circle ' Pine Knoll Shores, NC 28512 1 HA Al -?-NC 7004 1160 0003 1043 7872 `.. oJ4UOJo RJP Newport Development N' e J ive �0 Newp N. . 2 70 I /OTHER(o A ❑ INSUFFICIENT ADDRESS 0 c ❑ ATTEMPTED NOT KNOWN ❑ NO SUCH NUMBER/STREET S ❑ NOT DELIVERABLE AS ADDRESSED - UNABLE TO FORWARD '�r3�.. -- -................................................ 0 We \ s °ri s +rfemd�� G�M \""nh Caso����/ October 9, 2006 The Town of Pine Knoll Shores RJP Newport Development 123 Nine J Drive Newport, N. C. 28570 Reference: 109 Ocean Shore Lane Dear Mike: This letter is to advise you that the Town has applied for a CAMA permit to install a stormwater collection system for the Iron Steamer Beach Access. If I can be of further assistance, please advise. Sincerely, OP_ r Chris Jone Director O: CJ/lb and Public Property 100 Municipal Circle ♦ Pine Knoll Shores, North Carolina 28512 ♦ tele: 252-247-4353 fax: 252-247-4355 ♦ e-mail: admin _townofpks.com ♦ website: www.townofpks.com �4WP /0� Qine 3� o� o The Town of Pine Knoll Shores �stered�� f'� �O4h Cain>>�� • ( .` `,�e v 1 f: �1 October 9, 2006 NOV 1 4 Z006 Morehead Git� M'"a"'M RJP Newport Development 123 Nine J Drive Newport, N. C. 28570 Reference: 109 Ocean Shore Lane Dear Mike: This letter is to advise you that the Town has applied for a CAMA permit to install a stormwater collection system for the Iron Steamer Beach Access. If I can be of further assistance, please advise. Sincerely, oa .� Chris Jone Director G. CJ/lb and Public Property 100 Municipal Circle ♦ Pine Knoll Shores, North Carolina 28512 ♦ tele: 252-247-4353 fax: 252-247-4355 ♦ e-mail: adman townofpks.com ♦ website: www.townofpks.com UNITED STATES POSTAL SERVICE First -Class Mail f Postage & Fees Paid USPS Permit No. 0-10 • Sender. Please print your name, address, and ZIP+4 in this box • &4 ` ki4dq TOWN of PINE KNOLL SHORES 100 Municipal Circle Pine Knoll Shores, NC 28512 ■ Complete items 1, 2, and 3. Also complete Item 4 if Restricted Delivery is desired. ■ Print your name and address on the reverse. so that we can return the card to you. ■ Attach this card to the back of the mailplece, or on the front if space permits. 1. Article Addressed to: /a Red, i » 6 � � a/ 0g S�-� r -e.-e Al 5 /� nc a?s9 jme,�'Q -f lc� 1 ❑ Agent B (#%cei�/ed g'(P n ed Name) �. Date of Delivery e ((f% Id D. Is d livery address diffe M from item 1? ❑ Yes If YES, enter delivery address below: ❑ No 3. Serar c%e Te OR,gIst'e'X l O Express Mall ❑ Return Receipt for Merchandise Insured Mail O C.O.D. 4. Restricted Delivery? (Extra Fee) ❑ Yes 2. Mansferru� servke /aceq //l0 C093 Ps Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1540 A j0Xpine 0� d 0 ��11 efed��� \\0 Cato>>��/ October 9, 2006 The Town of fine Knoll Shores Mrs. Kay Redding 10108 Sea Breeze Drive Emerald Isle, N. C. 28594 Reference: 102 Ocean Shore Lane 108 Ocean Shore Lane Dear Mrs. Redding: I(_b NO V 1 4 2006 , "Oreheaa Ci s This letter is to advise you that the Town has applied for a CAMA permit to install a stormwater collection system for the Iron Steamer Beach Access. If I can be of further assistance, please advise. Sin erely, Chris Jones, Director Of Inspec onkan Public Property CJ/lb 100 Municipal Circle ♦ Pine Knoll Shores, North Carolina 28512 ♦ tele: 252-247-4353 fax: 252-247-4355 ♦ e-mail: admin _townofpks.com ♦ website: www.townofpks.com U� 6PostaljSer�viceT ' g ry TIFIED MAIL�RECEIPT'i ,CER -. (Domestic_ Mail Only; ;No.'/nsurance Coverage Provided) ,', OFFICIAL USE r-1 $ 3 Postage m p Certified Fee 0 p Postmark p Return Reciept Fee Here (Endorsement Required) p Restricted Delivery Fee (Endorsement Required) r-3 r=1 Total Postage & Fees $ r IQ ■ Complete items 1, 2, and 3. Also complete Rem 4 If Restricted Delivery is desired. ■ Print your name and address on the reverse so that we can return the card to you. ■ Attach this card to the back of the mailplece, or on the front if space permits.. 1. Article Addressed to: ('J�is 13, cl 570 %U 0 by (Printed Wife) / - I C. D. Is delivery address different from Item 1? U Yb' ff YES, enter delivery address below: ❑ No s1�Mail O Express u ress Ma Jo ^eglstered 13 Return Receipt for Merchandise 0 Insured Mail ❑ C.O.D. 4. Restricted Delivery? (Extra Fee) 0 Yes 2. ('rater��i�er 7� 1160 �3 10`�.3 %8.r� PS Form 3811, February 2004 Domestic Retum Receipt 102595-024A-1540 UNITED STATES POSTAL SERVICE First -Class Mail Postag USPSe &Fees Paid Permit No. G-10 • Sender. Please print your name, address, and ZIP+4 in this box • TOWN of PINE KNOLL SHORES 100 Municipal Circle Plne Knoll Shores, NC 28512 /4 � Qine 0 -r O y \�O'rh Caso/ October 9, 2006 The Town of fine Knoll Shores Mr. Otis B. Culpepper, III, Manager Bogue Shore Club 3124 Millcreek Road Newport, N. C. 28570 Reference: Bogue Shore Club Dear Mr. Culpepper: NOV 1 4 2006 Morehead City DC'M This letter is to advise you as manager of Hogue Shore Club, that the Town has applied for a CAMA permit to install a stormwater collection system for the Iron Steamer Beach Access. If I can be of further assistance, please advise. Sincerely, t Chris Jones, Director Of inspections and Public Property CJ/lb 100 Municipal Circle ♦ Pine Knoll Shores, North Carolina 28512 ♦ tele: 252-247-4353 fax: 252-247-4355 ♦ e-mail: adman antownofpks.com ♦ website: www.townofpks.com C3 Certified Fee n o 11 C3 Retum ROdept Fee I Postmark (Endorsement Required) LJ, O Restricted Delivery Fee Here -a (Endorsement Required) rl r- Totes Postage & Fees $ 6 OTHER PERMITS MAY BE REQUIRED: The activity you are planning may require permits other than the CAMA minor development permit. As a service we have compiled a list 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, SepticTank (or other sanitary waste treatment system), Building, Electrical, Plumbing, Heating and Air Conditioning, Insulation and Energy Conservation, FIA Certification, Sand Dune, Sediment Control, Subdivision Approval, Mobile Home Park Approval, Highway, Connection, and others. STATEMENT OF OWNERSHIP: TI M %3 5 5 / Li 3 $2� I, the undersigned, an applicant 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 described as: (check one) ++,, �j�n t F71, ' 7 an owner or record title. the is vested in nwU DF P M N fJl��/ f� ( , ; � - ; T 1 Q6e Deed B 1.1 r page in the County Registry of Deeds. an owner by virtue of inheritance. Applicant is an heir to the estate of h Q V 14 2006 probate was in County. Morehead City jDcR if other interest, such as written contract 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) (2) RN J (Z EDD1uG� IM OCZAR S1109Z LnnO,, KS (3) L ooi 06EAt SlnaR_q__ LAN X fgS (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 associ- ated with this lot. This explanation was accompanied by recommendations concerning stabilization and floodproofing tech- niques. 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 application, the ownership statement, the AEC hazard notice where necessary, a check for $100.00 made payable to the locality, and any infor- matiori as may be provided orally by the applicant. The details of the application 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 permit is subject to civil, criminal and administrative action. This th day o , 20 Landowner or person authorized to act as his agent for purpo e�Ofiling a CAMA permit application. 0 z SITE DRAWING/APPLICATION CHECKLIST Please make sure your site drawing includes the following information required for a CAMA minor development permit. The drawing may be simple and not necessarily to scale. The Local Permit Officer will help you, if requested. PHYSICAL DIMENSIONS Label roads Label highways right-of-ways Label local setback lines Label any and all structures and driveways currently existing on property PHYSICAL CHARACTERISTICS Draw and label mean high water mark Draw location of on -site wastewater system If you will be working in the ocean hazard area: Draw and label dune ridges (note height) Draw and label toe of dune Identify and locate first line of stable vegetation Draw and label setback line under CAMA Draw and label topographical features (optional) If you will be working in an estuarine shoreline area: Draw and label landward limit of AEC Describe terrain (slope) DEVELOPMENT PLANS ­\-: -(--i n �- rr--) pV ;A I GUotl ore 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 NOTE TO APPLICANT Have you: • completed all 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? FOR STAFF USE Site Notice Posted Final Inspection Fee Received Site Inspections Date of Action: Issued Revised 3/2003 Exempted Denied Appeal Deadline (20 days)