51333D - Perkins

1'CAMA/ Er-DREDGE & FILL 5
.ENERAL PERMIT Previous permit#
New El Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
rized by the State of North Carolina,Department of Environment and Natural Resources
:oastal Resources Commission in an area of environmental concern pursuant to I 5A NCAC (P/�T , I/to
❑Rules attached.
It Name l''E' d' , et /t l� Project Location: County /VG s-a- /1 0-14,
©- /- r; " 5 Streett Address/State Road/Lot#(s)
J Yi f',Pe State AJC ZIP -77' C° !90 I /I, I..C�s#vv /4 vl.
t(g/q) 7 77 26g,/ Fax#( ) Subdivision
zed Agent GI+.-) ;l`ev.1r' City 14h/Iy4tS//i'//1 ge4 e 1, ZIP 78 i
❑CW L7LW ❑'PTA ❑ES ❑PTS Phone# (94') 44V-7, Y%'/7River Basin Cr
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Wtr. Body �'
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❑PWS: ❑FC: /�
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ing permit may be required by: 7Q�1 /)�Y/4h7/�/ /-3
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OTHER PERMITS MAY BE REQUIRED:The activity you are planning may require per
Locality Permit Number ment permit.As a service we have compiled a listing of the kinds of permits that might be re
with your LPO to determine if any of these apply to your project.Zoning,Drinking Water W
Ocean Hazard Estuarine Shoreline ORW Shoreline Public Trust Shoreline Other treatment system),Building,Electrical,Plumbing,Heating and Air Conditioning,Insulation
(For official use only) Sand Dune,Sediment Control,Subdivision Approval,Mobile Home Park Approval,Highwa
GENERAL INFORMATION STATEMENT OF OWNERSHIP:
I,the undersigned,an applicant for a CAMA minor development permit,being eithe
LAND OWNER person authorized to act as an agent for purposes of applying for a CAMA minor del
Name GEo2E PeZIC.ias listed as landowner on this application has a significant interest in the real property c
D described as:(check one)
Address P.O.80x 515
�I //►►
pp an owner or record title,Title is vested in
City SPANeOR,O State I C. Zip 27330 Phone q19 - 777-201 page in the County Registry of Deeds.
AUTHORIZEDLA AGENT�,�,,�, [� an owner by virtue of inheritance.Applicant is an heir to the estate of
Name Hagior,(!RL f /� ! S i c./ ## C.STOAX, S. probate was in County.
Address P�.�a.80x Lul ai. Q gyp/ if other interest,such as written contract or lease,explain below or use a separa
Cit} faktiG(f State /VC Zip 27606 Phone 9(q- 831
nno• 9 is-YY3 3((17 NOTIFICATION OF ADJACENT PROPERTY OWNERS:
LOCATION OF PROJECT:(Address,street n e and/or directy'ins to site.If not oceanfront,w at is the nam TT the
adjacent waterbody.) MCI I( 7MLIC.I.N/4340 U�t,�c i�t[ rs()/Oa it.;.0 furthermore certify that the following persons are owners of properties adjoining th
/4 ACTUAL NOTICE to each of them concerning my intent to develop this property
.�(Name)� _I (Address-
DESCRIPTION OF PROJECT:(List all proposed construction and land disturbance.) (I) `d,1/�.K Kama...) s elOFARimE
/A;s74.e..e-AILov of NG-4.4_3 flUtiale. �O (2)kidWier fdtACKAISG-L' /903•tit l As;
(3)
SIZE OF LOT/PARCEL: 30,0O0 square feet acres CLooK' X0o') (4)
PROPOSED USE:ResidentialFOR DEVELOPERS IN OCEAN HAZARD AND ESTUARINE HAZARD AR
V (Single-family_Multi-family_) Commercial/Industrial I acknowledge that the land owner is aware that the proposed development is planne
Other to erosion and/or flooding.I acknowledge that the local permit officer has explained
TOTAL ENCLOSED FLOOR AREA O7 A BUILDING IN THE OCEAN HAZARD AREA OF ENVIRON-
MENTAL associated with this lot.This explanation was accompanied by recommendations cot
MENTAL CONCERN(AEC): A)A. square feet(includes all floors and roof covered decks) techniques.
SIZE OF BUILDING FOOTPRINT AND OTHER IMPERVIOUS OR BUILT-UPON SURFACES IN THE PERMISSION TO ENTER ON LAND:
I furthermore certify that I am authorized to grant and do in fact grant permission to
COASTAL SHORELINE AREA OF ENVIRONMENTAL CONCERN(AEC): AO square feet
(Calculations includes the area of the roof/drip line of all buildings,driveways,covered decks,concrete or masonry patios, enter on the aforementioned lands in connection with evaluating information related
etc.,that are within the applicable AEC.Attach your calculations with the project drawing.)
Choose the AEC area that applies to your property: This application includes:general information(this form),a site drawing as describe
(I)within 75 feet of Normal High Water/Normal Water Level for the Estuarine Shoreline AEC ownership statement,the AEC hazard notice where necessary,a check for$100.00 n
(2)within 575 feet of Normal High Water/Normal Water Level for the Estuarine Shoreline AEC,adjacent to information as may be provided orally by the applicant.The details of the applicatio.
Outstanding Resource Waters incorporated without reference in any permit which may be issued.Deviation from t
(3)within 30 feet of Normal High Water/Normal Water Level for the Public Trust Shoreline AEC of any permit.Any person developing in an AEC without permit is subject to civil,c
(Contact your Local Permit Officer if you are not sure which AEC applies to your property.) This the day of_
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 Landowner or person authorized to act as his agent for purpose of filit
If yes,list the total built upon area/impervious surface allowed for your lot or parcel: square feet.

ArA
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Michael F.Easley,Governor James H.Gregson, Director William G.Ross Jr.,Secretary
Date 8'7- O$
Applicant Name GoonGC 1062.61,35
Mailing Address P.D.,80x SZ.5
SA1,0414 A.A71.91+ C141.41uc.)11 2.7330
I certify that I have authorized(agent) /4,4R3UfzC2f. , (, 'pia to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct(activity) A /3UGIcl1 A.p //I
at(location) MO/ /l�ltg2it�4 / �/[1GFf'ir()L[K /V�. .
This certification is valid thru (date) 4 S R£:QUJ 111.0 •
Signature ��% � 2 / 4 ,

DIVISION OF COASTAL MANAGEMENT
• ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
\Tame of Individual Applying For Permit: aktefijsTep irakZ1.(r____c d.]1SZA7ft
kddress of Property: (O f / 12.171'j jMJ J/ Mj&JLLC
(Lot or Street#, Street or Road)
laU6 J1Ts'v!L L. QeAcit N C .
(City and County)
I hereby certify that I own property adjacent to the above-referenced property. The individua
applying for this permit has described to me as shown on the attached drawing the development the:
are proposing. A description or drawing, with dimensions, should be provided with this letter.
I have no objections to this proposal.
If you have objections to what is being proposed, please write the Division of Coasta
Management, 127 Cardinal Drive Extension, Wilmington, NC 28405 or call 910-796-721:
within 10 days of receipt of this notice. No response is considered the same as no objection i
you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boat house or boat lift must be sE
bck a minimum distance of 15' from my area of riparian access - unless waived by me. (If yo
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.
"114446�-kr ?-/7- 'F'
Si ame—.2)1 Date
VQY Mr e, r 4 /inn is e.lQ
Print Name A A

1 17 OH 1U: 57a Hal Focleman 910-270-3374 p. Z
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• DIVISION OF COASTAL MANAGEMENT
• ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
lame of Individual Applying For Permit: �h4'2 3d 'I A7 Lam, ,S L�
kddress of Property: (Q / A)j? -f 6.4,4hatk Mj4t1[
(Lot or Street #, Street or Road)
ILZIJJ kT tJl rg G NC
(City and County)
[ hereby certify that I own property adjacent to the above-referenced property. The individua.
applying for this permit has described to me as shown on the attached drawing the development the
are proposing. A description or drawing, with dimensions. should be provided with this letter.
I have no objections to this proposal.
If you have objections to what is being proposed, please write the Division of Coasta
Management, 127 Cardinal Drive Extension, Wilmington, NC 28405 or call 910-796-721:
within 10 days of receipt of this notice. No response is considered the same as no objection i
you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boat house or boat lift must be sf
bck a minimum distance of 15' from my area of riparian access - unless waived by me. (If yo
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.
_<
Sian Name Date
c
Print Name ' • •

,.17 08 10: 57a Hal Fogleman 910-270-3374 p. 2
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