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GENERAL INFORhIATION 1
LAND OWNER'' 1`
Name LA�S1-E nt 0,0 is i
Address C.' . . b/ ry r 134 UP, Pe 66
City eE-DA4''lpr3/ State /V e Zip '­O'3'fl Phone - q3 -35-2f
Email AID, &X L@ QML. C.a
AUTHORIZED AGENT
Name
Address
City State Zip Phone
Email
LOCATION OF PROJECT: (Address, street name and/or directions to site. If not oceanfront, what is the name of the
adjacent waterbody.)�5`3 L', r. vt� ' ''tee .`ems SZ ! +�
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DESCRIPTION OF PROJECT. (List all proposed construction and land disturbance.) l 0e-g- bq24 4-' 1T7fd -
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SIZE OF LOT/PARCEL: Z30.5' square feet acres
PROPOSED USE: Residential (Single-family E] Multi -family [ } Commerciat/lndustrial C] Other
COMPLETE EITHER (I) OR (2) BELOW (Contact your Local Permit Officer if you are not sure which AEC applies
to your property):
X(1) OCEAN HAZARD AECs: TOTAL FLOOR AREA OF PROPOSED STRUCTURE: 1Y# square feet (includes
air conditioned living space, parking elevated above ground level, non -conditioned space elevated above ground level but
excluding non -load -bearing attic space)
(2) COASTAL SHORELINE AECs SIZE OF BUILDINGFOOTPRINT AND OTHER' IMPERVIOUS OR BUILT
UPON SURFACES: square feet (includes 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.)
STATE STORMWATER MANAGEMENT PERMIT: Is the project located in an area subject to a State Stormwater
Management Permit issued by the NC Division of Water Quality?
YES NO
If yes, list the total built upon area/impervious surface allowed for your lot or parcel: square feet.

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November 4, 2015
Walter E. Corbett
PO Box 37579
Raleigh, NC 27627
Hello Walter,
I am writing you to notify you that I am applying for a Minor CAMA permit to
build a dirt berm on my lot on the other side of my house from your house. I am
hoping the berm will keep my lot from flooding on extreme high tides like we
have experienced this year. It will have no effect what so ever to your lot as it is
two lots over from yours and not "adjoining" this lot, but I am required to notify
you "of my intent to develop this property and to apply for a CAMA permit. So
this letter serves as my "Actual Notice" to you.
I hope you are doing well. If you have any auestions. you can call me at: 25?-
393-35315.
Sincerely,
W. Don Cox

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OTHER PERMITS MAY BE REQUIRED: The activity you are planning may require permits other than the CAMA
minor development permit, including, but not limited to: Drinking Water Well, Septic Tank (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. Check with your Local Permit Officer for more information.
STATEMENT OF OWNERSHIP:
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)
an owner or record title, Title is vested in �XJ C-y Z)d ' see Deed Book
page ZO in the CAaCr4v-'i County Registry of Deeds,
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 & 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
oivG'o�ri
(3)''
Ca f-
(4)
ACKNOWLEDGEMENTS:
I, the undersigned, acknowledge that the land owner is aware that the proposed development is planned for an area which
maybe susceptible to erosion and/or flooding. I acknowledge that the Local Permit Officer has explained to me the particu-
far hazard problems associated with this tot. This explanation was accompanied by recommendations concerning stabiliza-
tion and floodproofing techniques.
I furthermore certify that I am authorized to grant, and do in fact grant, permission to Division of Coastal Management staff,
the Local Permit Officer and their agents to enter on the aforementioned lands in connection with evaluating information
related to this permit application.'
This the - day of IV" . 20 t S
Landowner or perso . authorized to act as his/her agent for purpose 'of filing a CAMA permit application
This application includes: general information (this form), a site drawing as described on the back of this application, the
ownership statement, the Ocean Hazard AEC Notice where necessary, a checkfor $100.00 made payable to the locality, and
any information as may provided orally by the applicant. The details of the application as described by these sources are
incorporated without reference in any permit which maybe issued. Deviation from these details will constitute a violation of
anypermit. Any person developing in an AEC without permit is subject to civil, criminal and administrative action.