WO 37-15 Sanderson, Barbara

Locality � `--1.0 �K. V`+ Permit Number
Ocean Hazard Estuarine Shoreline
GENERAL INFORMATION
LAND OWNE
Name
ORV1' Shoreline ✓ Public Trust Shoreline Other
(For ggicial use onl))
Address to `, 5� or 61 ,-,Vg Lt:.-^,c
City C,i k State OC--- Zip,2-7L93 one _Q (cl-y,, 0 --6 jog
Email r !_i.�4 r1P_tt—
AUTHORIZED AGENT
Name l_z>
Address
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City
o hek
a z. A . i
State
N C
Zip ,''}Phone
Email
C{��.� 2rLLv +^rl
rtd OAt
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AQ.S. Caw:
LOCATION OF PROJECT: (Address, street name and'or directions to ite. If not oceanfront, w� a is the name of the i
adjacent waterbody)J,0�() C4.1A I/ ,�i r�/yt:41 tU L 2? 7t1
DESCRIPTION OF PROJECT: (List all prop psed construy,tign and land disturbance.) 6ctr�k��-'`=�
nc-1l<',(.� �.., rncht4 c•� �C, a e.j i �+rc cs
SIZE OF LOT/PARCEL:(; � square Feet 1 , 416 acres
PROPOSED USE: Residential Er (Single-family [g, Nlulti-family ) Cannlercialilndustrial Other
COMPLETE EITHER(I) OR (2) BELOW (C'ontact your Local Permit Officer if)-orr are Trot sure which AEC applies
to }'our property):
(.I) OCEAN HAZARD AECs: TOTAL FLOOR AREA OF PROPOSED STRUCTURE: 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 BUILDING FOOTPRINTAND OTHER DYIPERVIOUS OR BUILT
UPON SURFACES; square feet (includes the area of the roo ,'drip line of all buildings, driveways, covered decks,
concrete or masonry patios, etc. that are within the applicable AEC. Attach your calculations Nvith the project drawing.)
STATE STORNIWATER MANAGEMENT PERMIT: Is the project located in an area subject to a State Stormwater
Management Permit issued by the NC Division of NVater Quality?
Y1S= NC--;-1
If yes, list the total built upon area/impervious surface allowed .for your lot or parcel: __...... square feet.

OTHER PERMITS MAY BE REQUIRED:The activity you are planning may require penuits other than the CA;IMA
minor development pennit, including. but not limited to: Drinking kVater � ell, Septic `tank (or other sanitary, waste
treatment system), Building. Electrical, Plumbing, Pleating and Air Conditioning, Insulation and Energy Conservation, FIA
Certification, Sand Ihute, Sediment Control, Subdivision Approval, Mobile biome Park Approval, Highway Connection, and
others. Check with vaur Local Permit Officer for more information,
STATEMENT OF OWNERSHIP:
1, 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 developntent pennit, certify that the person
listed as landowner on this application has a significant interest in the real property described iherein. 'I'llis interest can be
described as: (check one)
Elan owner or recor � title Title is vested in r� - n _. } � 7,-,� �; ,.1, see Deed Book I —_
page L in the �te { _ County Registry of Deeds.
Flan owner by virtue of inheritance. Applicant is an heir to the estate of
probate was in _ County.
Lif 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 1 have given
ACTUAL NOTICE to each of them concerning my intent to develop this property and to apply for a CAMA pennit.
(Name) f A ddri-cK)
ACKNOWLEDGEMENTS:
I, the undersigned, 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 particu-
lar hazard problems associated with this lot. This explanation vvas accompanied by recommendations concerning stabiliza-
tion and floodproofing techniques.
I furthermore certify that 1 am authorized to grant, and do in fact grant, perttission to Division of Coastal Management staff,
the Local Pen -nit Officer and their agents to enter on the aforementioned lands in connection with evaluating information
related to this permit application.
This the �t—_ day of�—, 20 I
or person authorized to act as his,"her agent for purpose of filing a CANNA pennit application
This application inchides: t enei-al i forination (this foi-in), a site drairing as desci"tbed on the back of thus application, the
ou-nelshil) statement, the Ocean lfazarclAE'C Motiee where necessary; a check for 5100.00 made parable to the localit}: and
any, information as nm}• be provided orally by the applicant. The details of the application as describer) by these sources are
incorporated without reference in ant, permit which nt,,V be issued. Deviation fi-ont these details will constitute a violation of
anyl.wi-init. A)riy person developing in an AEC withiout pee -mil is sitbfect to civil, Criminal and administrative action.

CERTIFIED MAIL - RETURN RECEIPT REQUESTED
. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner:
Address of Property: i
La-,c 6k)c 9 ,k 77 kJ
(Lot or Street#, Street or Road, City & County)
Agent's Name #: _ �r G c.. %ll fv` Mailing Address:, i wt/ -7 ,} j�.�
Agent's phone #:.��-
I hereby certify that I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing the development
they are proposing. A description or drawing, with dimensions must be provided with this letter.
I have no objections to this proposal. I have objections to this proposal.
Ifyou have objections to what is being proposed, you mustnotify fhe Division of Coastal Management
(DCM) in writing within 10 days of receipt of this notice. Contact information for DCM offices is
available at www.nccoastalmanaaement neticontact dcm htm or by calling 1-888-4RCOAST. No
response is considered the same as no objection if you have been notified by Certified Mail
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set
back a minimum distance of 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 wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Pro•perty ner4nformation)
er
gnilture
t
Print or Type Name
Luoq
Mailing Address , S 03
CitylState p
_q(G - ,S ,KJ Cy I g
Telephone Number
Date
(Adjacent Property Owner Information)
Signature
81-Le-ry\e-L�1C
Print or Type Name
Mailing Addrjss
A�0.
CitylStatelZip
Telephone Number
Date
Revised 611812012

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONfWAIVER FORM
Name of Property Otivner:�;_'_
Address of Property: ( Srti� n, j ,`j�� r 69C, -�
(Lot or Streat , Streator Road, City & County)
Agent's Name #: y~ cZ (`� c: rr^, S Mailing Address:,
� i
Agent's phone #:2- 2Z-cl'1- {2?
I hereby certify that I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing the development
they are proposing. A description or drawing with dimensions must be provided with this letter.
t liave no objections to this proposal. _ 1 have objections to this proposal.
if you have objections to what is beingproposed, you must notify the Division of Coastal Management
(DCM) in writing within 10 days of receipt of this notice. Contact information for DCM offices is
available at www.nccoastalmanaaement neticontacf dcm htm or by calling 1-886-4RCOAST. No
response is considered the same as no objection if you have been notified by Certified Mail
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set
back a minimum distance of 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 wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(P ope Ow er Information)
. L11111'e
C-.r Gr► C'1 er-S ty
Print or Type Name
(Adjacent Property Owner Information)
Signa111re
Ie, Cj 1 i P. .,ri i
Print or Type Name
Mailing Address Mailing Address
plitylstaLta-filpnn-1
Cify/Slat Zip
Rtct,-`3w- (i,1
Telephone Number
-..._.__.._.__...._......__
Fate
Telephone Number
G::1;;
P,evised 61181-9012

CERTIFIED MAIL - RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner:
Address of Property:y� _ t1
(Lot or Street #, Street or Road, City & Coun
Agent's Name #: L:Jro-Q N- (2 ,Pf-i �.�.� .
5Mailing Address: ��..�L� � t;:� • . v (,•,)
Agent's phone #:,52--� (CU j 2,Z C t �!
i hereby certify that i own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing the development
they are proposing. A description or drawing with dimensions must be provided with this letter.
I have no objections to this proposal. f have objections to this proposal.
Ifyou have objections to whatis being proposed, you must notify the Division of Coastal Management
(DCM) in writing within 10 days of receipt of this notice. Contact information for DCM offices is
available at www.nccoastalmanaaement neticontact dcm htm or by calling 1-888-4RCOAST. No
response is considered the same as no objection if you have been notified by Certified Mail
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set
back a minimum distance of 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 wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Pro rty 0 n r Inf rmation)
t
.St teat e
Print or Type Name
Mailin Address 1�
CitylStateIZ
Telephone Number
Date
(Adjacent Property Owner information)
signature
-'-
Print or Type Name
Mailing Addresss,(._
CitylStatb2ip
Telephone Number
Date
Revised 611812012
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