76531D - Wellons

CAMA / X DREDGE & FILL N9 76531 A B
I'EN ERAL PERMIT Previous permit #
INew ❑Modification ❑Complete Reissue El Partial Reissue Date previous permit issued
ized by the State of North Carolina, Department of Environmental QualityLJ,'� O
oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC V �7 V r [j
�p Rules attached.
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a2120 20
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(Date)
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(Adjacent Property owner)
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(Mailing Address)
NrJhn,_Tx MSS_ loto00
(City, State Zip Code)
Dear Adjacent Property Owner:
U.S. Postal Service"
CERTIFIED MAIL° RECEIPT
Domestic !flail Only
For delivery information, visit our website at www.usps.com'.
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PS Form 3800, Apni 2015 PSn7530-02-000-9047 See Reverse for Insu
This letter is to inform you that I, 1�&P_YA d MC)ga_ have applied for a CAMA
(Property Owner)
Minor Permit on my property at 33AFla t&M,thi Ali (A . hew Hanover County.
(Property Add—)
As required by CAMA regulations, I have enclosed a copy of my permit application and project
drawing(s) as notification of my proposed project. No action is required from you or you may sign
and return the enclosed no objection form. If you have any questions or comments about my
proposed project, please contact me at 11Q" tA2-SI2_3 , or by mail at the address listed
(Phone Number)
below. If you wish to file written comments or objections with the Carolina Beach CAMA Minor
Permit Program, you may submit them to:
Miles Murphy
Local Permit Officer for the Town of Carolina Beach
1121 N. Lake Park Blvd.
Carolina Beach, NC 28428
Sincerely,

Permit Number
_ ORW Shoreline Public Trust Shoreline Other
(For official use only)
ifl�p ♦i �'i �
Zip Phone
t name and/or directions to site. If not oceanfront, what is the name of the
Cur 1tf%Bmcy) M� +
rposed construction and land disturbance.) �i1\I��1'�Gtx 11'1
square fed k acres
le -family Multi -family ❑ ) Commercial/Industrial ❑ Other ❑
(Contact your Local Permit Officer ifyou are not sure which AEC applies
OR AREA OF PROPOSED STRUCTURE: square feet (includes
rbove ground level, non -conditioned space elevated above ground level but
)F BUILDING FOOTPRINT AND OTHER IMPERVIOUS OR BUILT
es the area of the roof/drip line of all buildings, driveways, covered decks,
the applicable AFC. Attach your calculations with the project drawing)
PERMIT: Is the project located in an area subject to a State Stormwater
t of Water Quality?
surface allowed for your lot or parcel: square feet.
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, Nesting 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 LAMA 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) �' ""� �-�
A —an owner or record title, isle is vested in MJCtA n & 0 Wt,,�MG see Deed Book � L W
page � Z in the tAftq 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 OFADJACENT 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)
(2)
(3)
(4)
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. 1 acknowledge that the Local Permit Officer has explained to me the particu-
lar hazard problems associated with this lot. This explanation was accompanied by recommendations concerning stabiliza-
tion and floodproofing techniques.
I furthermore certify that 1 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 VIh day of .20
�1 nl�» l�lfll�llm. �v i4n., a wo I � ) Lo-
LandAner or person authorized to act as his/her agefit 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, tire
ownership statement, the Ocean Hazard AEC Notice where necessan,. a check for S 100.00 made ptnable to the locality, and
uny information as ma"r be provided oraNv br the applicant. The details of the application as described t!v these survives are
incorporated without rrfentnce in any permit which mar he issued. Deviation from these details will constitute a violation of
anv permit. Anv person developing in an AEC without permit is subject to civil, criminal and administrative action.
r

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An4hna R -Tx) ► -R ►�,r }hy G. I.e�
(Adjacent ro Ay owner) JgpC M. &C8V4 if)
C%q noy t& AYc
(Mailing Address)
Ca>ro��na3eoch, nc aQA26
(City, State Zip Code)
Dear Adjacent Property Owner:
This letter is to inform you that I, !' oher��. W OV IS have applied for a CAMA
(Property owner)
Minor Permit on my property at Fletidn Pw. et&4nh in New Hanover County.
(Property Address)
As required by CAMA regulations, I have enclosed a copy of my permit application and project
drawing(s) as notification of my proposed project. No action is required from you or you may sign
and return the enclosed no objection form. If you have any questions or comments about my
proposed project, please contact me at ft-M9 U3 , or by mail at the address listed
(Phone Number)
below. If you wish to file written comments or objections with the Carolina Beach CAMA Minor
Permit Program, you may submit them to:
Miles Murphy
Local Permit Officer for the Town of Carolina Beach
1121 N. Lake Park Blvd.
Carolina Beach, NC 28428
Sincerely,
eD_%. PmI1 � iA11%,11—

NC Division of Coastal Management
Cashier's Official Receipt
Received From: I �P 1 r��, I t [ flL
Permit No.: T31 �(� I
Applicant's Name: ec wi Lr Sii I�u we 16ms
Project Address:
23 3 Ave-,7 vt-
10765 A B C D
Date: 4 / 17 20 .2-12
Check No.: d2 606
County:��
Please retain receipt for your records as pWof of payment for permit Issued.
Signature of Agent or Applicant: Date: a
Signature of Field Representative: Date:

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