15-07_Raymond Luker_20071023

Morehead City -
Local Government
GAIVIA
MINOR DEVELOPMENT
a 4 ZINI 11
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"
15.07
Permit Number
Issued to Raymond Luker, authorizing development in the Estuarine Shoreline (AEC) at 375 Ball Farm Road, in
Newport, as requested in the permittee's application, dated October 12, 2007. This permit, issued on October 23, 2007,
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: Installation of 350' of 48" diameter pipe, backfill, sump drains, catch basin and check dam.
(1) All proposed development and associated construction must be done in accordance with the permitted work plat
drawings(s) dated received on October 12, 2007.
(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 [phone] 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, 2010
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.
AdG2-,W1
Brad Connell
NCDCM Coastal Field Representative
400 Commerce Avenue
orehead City, NC 23557
PERMITTEE
(Signature required if conditions above apply to permit)

Name: Raymond Luker
Minor Permit # 15-07
Date: October 23, 2007
Page 2
(5) 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 marsh or water areas, until such time as the area
has been properly stabilized with a vegetative cover.
(6) All other disturbed areas shall be vegetatively stabilized (planted and mulched) within 14 days of construction
completion.
(7) All work is to be 30' landward of normal water level. This permit does not authorize development within any
wetlands or open water areas.
� S^
SIGNATURE:
.DATE:
PERMITTEE

NC®ENR
North Carolina Department of Environment and Natural Resources
Devi i of �'aal Vl9emwt
Michael F. Easley, Govemor James H. Gragm, Director William G. Ross Jr., Secretary
October 23, 2007
Raymond Luker
375 Ball Farm Rd.
Newport, NC 28570
Dear Mr. Lucker:
Attached is CAMA Minor Development Permit # 15-07 for installation of 350' of 48" diameter
pipe, backfill, sump drains, catch basin and check dam. at 375 Ball Farm Rd. Newport, NC
28570. .
In order to validate this permit, please sign both copies as indicated. Retain the original (yellow
copy) for your files and return the signed copy to us in the enclosed, self-addressed envelope.
Your early attention to this matter would be appreciated.
Sincerely,
'406.1 �
Brad Connell
Coastal Management Representative
lsb
Enclosures
400 Commence Avenue, Morehead City, North Carolina 28557
Phone: [phone] \ FAX: [phone] \ Internet: www.nccoastaimanagement.net
An Equal Opportunity 1 Affumative Acton Emplover— 50% Realdeci110°% Post Consumer Paper

, 1
Morehead City
Local Government
CAM
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"
15.07
Permit Number
Issued to Raymond Luker, authorizing development in the Estuarine Shoreline (AEG) at sty hall t-arm Koau, in
Newport, as requested in the permittee's application, dated October 12, 2007. This permit, issued on October 23, 2007,
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: Installation of 350' of 48" diameter pipe, backfill, sump drains, catch basin and check dam.
(1) All proposed development and associated construction must be done in accordance with the permitted work plat
drawings(s) dated received on October 12, 2007.
(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 [phone] 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 Brad Connell
modification not covered under this permit, require further written permit NCDCM Coastal Field Representative
approval All work must cease when this permit expires on: 400 Commerce Avenue
DECEMBER 31, 2010 Morehead City, INC 28557
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 - PERMITTEE
Management. (Signature required if conditions above apply to permit)

Name: Raymond Luker
Minor Permit # 15.07
Date: October 23, 2007
Page 2
(5) 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 marsh or water areas, until such time as the area
has been properly stabilized with a vegetative cover.
(6) All other disturbed areas shall be vegetatively stabilized (planted and mulched) within 14 days of construction
completion.
(7) All work is to be 30' landward of normal water level. This permit does not authorize development within any
wetlands or open water areas.
SIGNATURE:
PERMITTEE
DATE:

ow,
-
.
C
APPLICATION FOR"
%c� t C MINO�,R
i� ;�
�,►{,� r A_ DF-T.&JPMEN'�'
,
it
x VERMIT.
' ,
a I In 19 ' 4,3'the North Carolina General Assembly passed the Coastal Area
Management Act and set the stage for guiding development in fragile
I !!� 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 for 'a minor development permit under CAMA is part
• of,the Commission's effort to meet the sport and intent. of the General
>I -.
Assembly. It has been designed to be straightforward and require" no
more time or effort necessary from the applicant. Please go over this
s
folder with the Local Permit Officer (L'P}}O)for the locality in which you
plan to build; to be certain that you understand;whatinformation he or
N ; she'needs. y'
�i Under CAMA regulations, the minor permit is°to be issued within 25
days once a complete application
the, ro ect is simple'. � The rocess in hand: Often less time is needed if
18
is
�-cans eed'the a poyal o process' ner'allytakes about days. -You
ss b makin g certain that our application
i b is coin fete an pP . 3� P o , Y,
g Y PP
f p d signed, that your drawing meets the specifications given .
.: inside and that your application fee is attached.
Other permits are sometimes required for development in the coastal
area:; While these are not CAMA-related, we urge you to check with he
Local Permit Officer to determine which of these you may need. A
' listing is included on page 2 of this folder.
•
xt
We appreciate your cooperation with the North Carolina Coastal Man
age'ment Program and your. willingness to build in a way that protects
4, �� : ` the resources of our beautiful and productive coast.
e 9 - Coastal Resources Commission
Wk
„ Division of Coastal Management ' Y
a �1
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1

Locality Permit Number
Ocean Hazard, Estuarine Shoreline ORW Shoreline Public Trust Sh
(For official.use only)iu
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GENERAL INFORMATION OCT 12 2007
LAND OWNER Morehead City DCAA
Name M o � a a . 1—V 1F
Address , 7 ,— A,Z k 4 ,00 /e
City /V :F /,rJ J0D A 7— State Zip v Phone
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?) ILAA�Pbf) /V UR FORT e-kflX CANS,►- ,Z
DESCRIPTION OF PROJECT: (List all proposed construction and land disturbance.)
zws-r4-4t 418''PmE IA✓ ,6IeA1A'A6£ vW_ _/�JI S/D i o F A.eo)157x � �_ /•�571�1�
s1. m !' o.4JN5 4AIo Gur7-5 _ okA>•ds TD e/ ,Mle. £ 1/A.A)Ce CATCJ) RS--lA,)
AT s7-A ey-o p, Ojel vr&14-Y. RJP-A,9P CNtr_-l_! O#M /t-T CAIV --A fr/A D-F- P)Jl t.
SIZE OF LOT/PARCEL: square feet A 7 oZ 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):
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): / 30 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.)
Choyise the AEC area that applies to your property:
(1)Vwithin 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 STORIVIWATER 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, square feet.

Message Confirmation Report
Name/Number
97262653
Page
2
Start Time
OCT-12-2007 12:41PM FRI
Elapsed Time
001301,
Mode
STD ECM
Results
[O.K]
OCT- 12-2007 12:41 PM FRI
Fax Number : 2522473330
Name DCM MHD
N
OCT 12 2007
MOreh aq C'it,Ty
DIVISION ON COASTAL MANAGEMENT
A IT 0
4 jj ��
NCDENR
TO: CARTERET NEWS TIMES
OFFICE.
TELEPHONE [phone]
FAX 252-7(2�6- 0%
FROMIG�C`,
MOREHEAD CITY OFFICE
400 COMMERCE AVENUE
MOREHEAD CITY, NC 28557
VOICE:252-808.2808
FAX: [phone]
RE
DATE SENT: 1 Q -1,')- -1
TOTAL PAGES, INCLUDING COVER SHEET:

DIVISION OF COASTAL MANAGEMENT
TO: CARTERET NEWS TIMES
OFFICE
TELEPHONE [phone]
FAX 252-726lp�
FROM
MOREHEAD CITY OFFICE
400 COMMERCE AVENUE
MOREHEAD CITY, NC 28557
VOICE:252-808-2808
FAX: [phone]
RE:
DATE SENT: 10 - I Z- ()--I
TOTAL PAGES, INCLUDING COVER SHEET:

NOTICE OF FILING
OF APPLICATION FOR
CAMA MINOR DEVELOPMENT PERMIT
Pursuant to NCGS 113A-119(b), the NC Division of Coastal Management, authorized
to issue CAMA permits in Areas of Environmental Concern, hereby gives NOTICE that on
October 12, 2007, Raymond Luker applied for a CAMA permit to install a pipe, gutter
drains, catch basin, and check dam at 375 Ball Farm Road in Newport, Carteret. County
adjacent to Harlowe Creek.
The application may be inspected at the address below. Public comments received by
October 25, 2007 will be considered. 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.
Brad Connell
NC Division of Coastal Management
Field Representative
Address: 400 Commerce Ave.
Morehead City, NC 28557
Phone:[phone]
PLEASE PUBLISH ON: October 17, 2007

FOR
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DATE ,p TIME P.M.
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AREA CODE NUMBER EXTENSION
❑ FAX
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.ELEPHQNECi
PLEASE CALL
CAME TO SEE YOU
111/tU CALL. AGAli11
NANTS TO SEE Y
RUSH
RETURNEC3 YOUR CALL
!SPECIAL ATiEit[fN
MESSAGE
SIGNED
W■Y�FORM 3002P
MADE IN U.S.A.

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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORMG PILIIVGSBOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to RAYmtd.4 t JZAC-FJ /-VA'ips
(Name of Property Owner)
property located at ,(OT.Z , yS QAU PAeoh R 0, N.,-W)OLW - ,ye �tcy f 7y
(Lot, Block, Road, etc.)
on _7-IN rtoc✓t r�vJ3eooT �'ANAa- , in Ch e7-,-, X�E T r OaN 7-y . N.C.
(Waterbody) (Town and/or County)
He has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal. I understand that a pier/mooring pilings / boatlift / boathouse
must be set back a minimum distance of fifteen feet (15) from my area of riparian access unless
waived by me. (If you wish to waive the setback, you must initial the appropriate blank
below.)
I do not wish to waive
I do wish to waive that setback requirement.
----------------- ---------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSIBOATLIFTIBOATHOUSE)
I hereby certify that I own property adjacent to .RAYmtd,0 t STi4011 ,, Y-Fh Vs
(Name of Property Owner)
property located at /DT-Z , ? yS QA-U PAPin R 0, ,Vs-w)04W T A-Jc- R(f f7D
(Lot, Block, Road, etc.)
on n n giyive o� vJ3FoaT rANA� , in C, Ok y- )°f T C OaA, 7'y N.C.
(Waterbody) (Town and/or County)
He has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal. I understand that a pier/mooring pilings / boatlift / boathouse
must be set back a minimum distance of fifteen feet (I T) from my area of riparian access unless
waived by me. (If you wish to waive the setback, you must initial the appropriate blank
below.)
I do not wish to waive
—X— I do wish to waive that setback requirement.
------------------------------------------------------------------------------------------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
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Page 1 of 1
CARTI ET CQUtiTlf
eeitarze
S36a.00
$ OReal Estotie
Exoise Tax
Excise Tax; $360-00
Melanin A a as
��l;VFt:Fr eauNrr
MR Date 00/18/ O05 71rne 08r46:00
GR 1127ma Page I. raf 3
NORTH MOLINA. CAC+TEFIt WWUNTY
The tomsoh Q cer,603*41 o(t OWV (a) lass
C,OM%ed 10 ttti Ctaato, This inswmant and NO COM-
aata are c'tt'yt rvaig rod at the d 3te and tine 4 io
Usti BOok asxt Parma ,s?yrat ran the Gtst Qape teat.
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NORTH CAROLINA GENERAL WARRANTY DEED
Parcel IdentifierN0,t1 }'1113.44.2911 Vmiedby County on the_ day of .20
Bfy;
I----
IvisiUBox to; Stricklm Law l irrn, P.A., 48 WestbruokeShoppinF.Center, havelock, NC'2$�32
Ws irut ummnt was prepared by, Str.'ckl-n Late Finn. P.A., a-t$ Westbrooke Shn ing Center. tWclodk NC 28532
Brief deuriptioa for the [ruder: LT I & PT OF 2 ADAMS LANDII Ci
THIS DEED made Ibis 171. day of Anyost . 20j'% by and between
GRANTOR
Lloyd N. Rose and:vire,
Gwca Rust
GRANTEE
Iiaymand A Luker and wife,
Stacey S, Luker
375 Uall Farm Road
Nmport, NC 2SS70
The da ipatioa Creator autl Gratnttee ss geed hmvin shall include said pnrtics, their heirs, s"vessori, and aisiyltts, and shall ita:lutie
singular, plural, mitsculim, fet.mme or neuter as rtquimd by contest
WITNESS M.. that the t*u mw. for a valuable coasideration paid by the irramre, the receipt of which it Wtby ackraawledi vd, has
aad by these presenss does grant, bargain, sell and cooveytmto On Ginnie in fee simple, all that eattain lotorparcel of b ad sibuted
in the City of Nevlxrrt hart-kc Towmhip, Cancrct Cwmty,NutiltCartsiaaand
more puticulmly desmbed ai tollowsa
See Auach"
TbcpropertyhereiaaboredeaerIedwasacquiredbyCuaetarbyim unewrecordedit►Book 105S pale 303
A map Aowiicg dK above described property is romotdcd in Platt !look: 29 page 591
http://nc-carteret-recorder.govenunax.com/recordmaxlRoverpocumentsll9901171266P-1... 10/ 12/2007

Page 1 of 1
TOIIAVE AN76 TO HOLD the afosesald lot or pareei of load and all pr vilrges nand app itttaxaces thetdobelpvg4 to the Cnaotee
is fee simple.
And the Grantor covenants with the Grantee, that t3raraor is seized of the pttndsca in fen &*3c, has the right to convey the same in
fee sitnplr, that title is marketabla and free sad cleat of all cawntbrastcca, and that Ontator w ilt warrant and defend the tide agautst
the IArrfitl clabria ofall persons whoaraocver, other than Lk following exceptioos:
Euct ots and Restrictions of rrcurtl.
Ili WnWFSS WHEREOF, the Grantoz has duly executed tine fcresoi as of the day pdytar t above writ:at.
CAL)
(Entity Name) IMI R
Title: Gwen Rosa
tly�
Title:
ny:
Mile
State of NoMh Camlina - County of kited[ C r avcn
I, the undersigned Notary Public of the County and State aforesaid, cer:W that Uavd N. Roca and wife, Crwen Rssrc
personally appcttcd bcforo we die day and
acknowledged the due exccat;iva of the foregoing inatranaent for the purposes thorn d. Wittsess my hand a>xi riS1"�
stamp or reel this _17ttt_ day of August . 2Q OS �,,,•''''�
MyC=Ta 3rionExpires.-September25.2009
I, the undersigned NotwyFublkofthe tiI'
personally enure before mo this day uA acltttow as ue s the of
a North Catolma or
cotpontiatallirttited IiakiGry carrtrs,n}dRcacral pAtinershiptimited putrrership (elrtYa tbrou,git the Istisuppli�bla}, aaxl
that by authority duly given and as the act of such entity _6c signed the fixegolug iastttuneat in its mane oa its behaU`as its act and
deed. Witness my bind and Normal slang or seal. ibis day of _ . 20 _
MY Cottaeassioa Expires:
Notary Public
State ofNorth Carolina • County of
L the u ndcrsigacd Notary Public of the County nod State aforesaid, certify that
Witness tray hand nail Notarial stan^a, or seal, this slay of . 24___.
My con=r scion Erpimv-
Notary Public
JIM foregoing C,ertgkItc(s) of BOUDY J. btXICALL11
Ware wtiUd W be m=L Ms warumcat and this catirkatc are dudy togisteredat ttxt date Arad titw Arad lathe &aoiand Page shown
on the first page hornet C ar to r e r
Register of Mods for Casmty
8y; Dq*uW. Assistant - Rcpisur of tkods
http://nc-carteret-recorder. governmax.corn/recordmax/Roverpocuments/019901171266P-... 10/12/2007

Page 1 of 1
ATTACHMENT
All that certain lot or percel of land situated in Hartok+'e'Township, Carteret County, North Carolina and mores
R"cularly described as IDIIows:
BEING all of Lot #1 and arks nodhern one-half of Lot #2 of Adams Landing SubdNiston as originally shown o7 a map
or plat thereof recorded in Map Book 28, Page 176. Carteret County Registry, and as revised on a map or plat
entitled "Adams Landing Subdlyision• Recombination of Lots No. One. Two, and Three" recorded In Map Book 28.
Pape $91. Carteret County Registry. Said parcel being more particularly described by metes and bounds as fo4mvs:
BEGINNING at a point in the southern right of way of Bail Farm Rid and marking the norrioast corner of Lot #1 as
shown and delineated on fho aforesaid maps. Thence from this point and place of beginning along and with the
southern right of way of Bail Farm Road South 28 degrees 27" 36" East 1156.58 fact to a now iron rod; thence running
South 61 degrees 34' 12" West 416.18 feet to a point; thence running North 28 degrees 46' 40" West 203,33 feet to a
point; ttronco running North 67 degroas 57' 41" East 419-94 feet to the point and place of beginning,
This conveyance is made subject to the right of way of S.R.1391, covenants, restrictions and easements of record,
and the rights of others in and to the eaters of the Harlowe Clubfoot Canal.
http://nc-carteret-recorder.governmax.corn/recordmax/Roverpocuments/019901171266P-... 10/12/2007

OTHER PERMITS MAY BE REQUIRED: The activity you are planning may require permits other than the CAMA minor y
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 114
with your LPO to determine if any of these apply to your project: Zoning, Drinking Water Well, SepticTank (or other sanitarywaste
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, anPV a
►.t
ivJJ1 O
STATEMENT OF OWNERSHIP: OCT 12 2007
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 per V&tgi - nOC
listed as landowner on this application has a significant interest in the real property described therein. This interest can be
described as: (check one)
an owner or record Utle. Title is vested in , see Deed Book
page ? -7 in the V et County Registry of Deeds.
% s5
an owner by virtue of inheritance. Applicant is an heir to the estate of
probate was in County.
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)
(1) _S�-FP�IPr�Ir 4 .Q Pnx/nJ AMS' sqM d rfiybj /U O1✓/d6 S .AO oV 7,36
(2) aLA FA'em a Ah—'
(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 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-
mation 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 the /;,7114day of OGT0 Rfoe- , 20 o 7
Landowner or person authorized to act as his agent for purpose of filing a CAMA permit application.

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
TZ ou
OCT 12 2007
lVIoreMead C++Y UCII
1� 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
_,v— Describe composition of surface
Note and list fully all trees and vegetation to be removed or relocated
f 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?
Site Notice Posted
Site Inspections
FOR STAFF USE
Final Inspection Fee Received
Date of Action: Issued Exempted
,Denied Appeal Deadline (20 days)
Revised 3/2003