SC_19-19_ Lee

,
Issued by WiRO SC19-19
Surf City Permit Number
CAMA
MINOR DEVELOPMENT
PERMIT
NORTH CAROLINA
Environmental Quality
as authorized by the State of North Carolina, Department of Environmental Quality
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"
Issued to Wilba Jean Lee authorizing development in the Estuarine Shoreline (AEC) at 1017 1st Street, in Surf City,
Onslow County as requested in the permittee's application, dated April 4, 2019, and received by DCM on April 22, 2019.
This permit, issued on May 10, 2019, is subject to compliance with the application and drawing dated and received by
DCM on April 22, 2019 (where consistent with the permit), all applicable regulations and special conditions and notes set
forth below. Any violation of these terms may subject the permittee to a fine, imprisonment or civil action, or may cause
the permit to be null and void.
This permit authorizes: Proposed residential dwelling with driveway and parking areas.
(1) All proposed development and associated construction must be done in accordance with the permitted site drawing dated
received by DCM on April 22, 2019.
(2) Any change or changes in the plans for development, construction, and/or land use activities will require re-evaluation and
modification of this permit.
(3) A copy of this permit shall be posted or available on site throughout the construction process. Contact this office at(910)
766-7221 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. This permit must be on the project
site and accessible to the permit officer when the project is inspected for Jason Dail
compliance. Any maintenance work or project modification not covered under CAMA LOCAL PERMIT OFFICIAL
this permit,require further written permit approval.All work must cease when this
permit expires on: 127 Cardinal Drive Extension
Wilmington, NC 28405-3845
December 31,2022
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 w�
another party without the written approval of the Division of Coastal PPRMITTPP

Name: Wilba Jean Lee
Minor Permit#SC19-19
Date: May 10, 2019
Page 2 of 3
(4) All unconsolidated material resulting from associated grading and landscaping shall be retained on site by effective
sedimentation and erosion control measures. Disturbed areas shall be vegetated and stabilized (planted and
mulched)within 14 days of construction completion.
(5) Any proposed for grading within the 30' Coastal Shoreline buffer (as measured from the Normal High Water level)
must be contoured to prevent additional stormwater runoff to the adjacent marsh and/or canal. This area shall be
immediately vegetated and stabilized and must remain in a vegetated state.
(6) All development, unless specifically exempted in this permit, shall be located at least 30' landward of the normal
high water line.
(7) No impervious coverage/built upon area, including but not limited to the house (including eaves), foundation pad,
covered decking,etc.shall extend into the 30-foot coastal shoreline buffer.
(8) Shall the plan of development exceed 30% impervious coverage within 75' of the normal high water line, the
applicant shall effectively demonstrate, through innovative construction and design that the amount of impervious
surfaces exceeding 30% impervious coverage within the 75' Coastal Shoreline AEC shall be managed and the AEC
protected. All proposed development and associated construction must be done in accordance with a credible
innovative design plan,sealed and sealed by a professional engineer.
(9) Upon completion of construction and prior to the issuance of a Certificate of Occupancy(CO), a letter of certification
must be received from the designer of the innovative system installed, certifying that the permitted system has been
installed in accordance with this permit, the approved plans and his design specifications. Any deviations from the
approved plans and specifications must be noted on the Certification and a permit modification may be required
prior to receiving a CO.
(10)All structures shall comply with the NC Building Code, including the Coastal and Flood Plain Construction Standards
of the N. C. Building Code, and the Local Flood Damage Prevention Ordinance as required by the National Flood
Insurance Program. If any provisions of the building code or a flood damage prevention ordinance are inconsistent
with any of the following AEC standards,the more restrictive provision shall control.
(11)Pursuant to 15A NCAC, Subchapter 7J.0406(b), this permit may not be assigned, transferred, sold or otherwise
disposed of to a third-party.
SIGNATURE:61 DATE: ` t5"1
PERMITTEE

lit, Permit Number OTHER PERMITS MAY BE REQUIRED:The activity you are planning may require permits other than the CAMA
minor development permit,including,but not limitedto:Drinking Water Well,
Tank(or other sanitary waste
n Hazard Estuarine Shoreline ORW Shoreline Public Trust Shoreline Other treatment system),Building,Electrical,Plumbing,Heating and Air Conditioning,Insulation and Energy Conservation,FIA
(For official use only) Certification,Sand Dune,Sediment Control,Subdivision Approval,Mobile Home Park Approval,Highway Connection,and
others.Check with your Local Permit Officer for more information.
IERAL INFORMATION
STATEMENT OF OWNERSHIP:
'D OWNER-MAILING ADDRESS I,the undersigned,an applicant for a CAMA minor development permit,being either the owner of property in an AEC or a
WAS9 �( (�E 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
ess ` gt-9A Ce )2 described as:(check one)
G N4INZ State rrL Zip 175"lPhone (g -3 G y "5' z S- ,d/an owner or record title,Title is vested in name of W t`$A 3-e's.' l.�Z
1 see Deed Book 1 3(.1 page t 51 in the d 5 L-8"-' County Registry of Deeds.
HORIZED AGENT / an owner by virtue of inheritance.Applicant is an heir to the estate of
7804 AO 5 5_7-1-1. 1/ 7't/1Lt =-5 ;probate was in County.
ess
60 3 U C W,4 (-7 if other interest,such as written contract or lease,explain below or use a separate sheet&attach to this application.
�2
(h i'1 QS,---vr� State NL Zip��`-Phone (J 'D 1 33 l� NOTIFICATION OF ADJACENT RIPARIAN PROPERTY OWNERS:
` I furthermore certify that the following persons are owners of properties adjoining this property.I affirm that I have given
I ✓G -dt-e S t`C - C Cr'e+'1 ACTUAL NOTICE to each of them conceming my intent to develop this property and to apply for a CAMA permit.
:ATION OF PROJECT:(Address,street name and/or directions to site;name of the adjacent waterbody.) (Name) (Address)
(1), ?Bt , p4v�-4 (mew 316 QlcdDttoe RC •1►e.ksaNY �
J( ) 6r Si $ufsF NC- ��(y ›-1/4
(2) every GJprt5L -f 10(5 lsr sr SL, Ct j . _ �44.5
(3)
(4)
CRIPTION OF PROJECT:(List all proposed construction and land disturbance.) 26)60 N' 'c ACKNOWLEDGEMENTS:
/ f' t( PO/Le,(4 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 was accompanied by recommendations concerning stabiliza-
OF LOT/PARCEL:
LOT/PARCEL: voo square feet 0-15 acres tion and floodproofing techniques.
POSED USE:Residential (Single-family iMulti-family❑) Commercial/Industrial O Other 0 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
IPLETE EITHER(1)OR(2)BELOW(Contact your Local Permit Officer if you are not sure which AEC applies related to this permit application.
ur property):
)CEAN HAZARD AECs:TOTAL FLOOR AREA OF PROPOSED STRUCTURE: t 1 y This the day of 20
square feet(includes
mditioned living space,parking elevated above ground level,non-conditioned space elevated above ground level but
[ding non-load-bearing attic space) d or authorized to act as his/her agent for purpose of filing a CAMA permit application
:OASTAL SHORELINE AECs:SIZE OF BUILDING FOOTPRINT AND OTHER IMPERVIOUS OR BUILT
N SURFACES:((11'square feet(includes the area of the foundation of all buildings,driveways,covered decks, This application includes:general information(this form),a site drawing as described on the back of this application,the
and ownership statement,the Ocean Hazard AEC Notice where necessary;
rete or masonry patios,etc.that are within the applicable AEC.Attach your calculations with the project drawing.)
necessary;a check for$100.00 made payable to the locality,
any information as may he provided orally by the applicant.The details of the application as described by these sources are
fE STORMWATER MANAGEMENT PERMIT:Is the project located in an area subject to a State incorporated without reference in any permit which may be issued.Deviation from these details will constitute a violation of
nwatfrManagement Permit issued by the NC Division of Energy,Mineral and Land Resources(DEMLR)^ any permit.Any person developing in an AEC without permit is subject to civil,criminal and administrative action.
4/ NO_
;,list the total built upon area/impervious surface allowed for your lot or parcel: 6 O square feet. RECEIVED
APR 2 2 2019

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: bt)'�8� '—
Mailing Address: 490R Lem: r (2_
"ac a--IS Z`)
Phone Number: � I 1 3‘ y aS_
Email Address:
I certify that I have authorized / �'S `�` / v,2t 1-� '�` h
Agent/Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: s A, «
at my property located at / T g�- S u2 F ' c_ 4 y
in 0NSc-vLA.2 County.
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.
Property Owner Information:
/A/IP/4v I CA
ignature
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Print or Type Name
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io his certification is valid through
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CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner: Got c"5 Fi v��i L
Address of Property: i a'•' / 9' S i• S U' / C ( 71-i N c_ a-S `(1{
(Lot or Street#, Street or Road, City&County)
Agent's Name#: 7-6'4'1 4-`'95 1c- /1-`-' ` 146 ./lailing Address: I ()GI' ° 5 t4w'1 r 7
Agent's phone#: t `' &Ya �'' i t+ t/�,(� ,p tv` S t`t"3
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.
If you have objections to what is 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 athttp://www.nccoastalmanagement.net/web/cm/staff-listing 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, boat ramp, breakwater, boathouse, or lift 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.
d)
(Property4Owner Informati n) (Riparian Property Owner Information)
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delivery. LISPS®-postmarked Certified Mail receipt to the
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signature)that is retained by the Postal Service'" -Restricted delivery service,which provides
for a specified period. delivery to the addressee specified by name,or
to the addressee's authorized agent.
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First-Class Mail®,First-Class Package Service®, available at retail).
or Priority Mail®service. -Adult signature restricted delivery service,which
I Certified Mail service is not available for requires the signee to be at least 21 years of agi
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Insurance coverage is notavailable for purchase by name,or to the addressee's authorized agent
with Certified Mail service.However,the purchase (not available at retail).
of Certified Mail service does not change the •To ensure that your Certified Mail receipt is
insurance coverage automatically included with accepted as legal proof of mailing,it should bear a
certain Priority Mail items. USPS postmark.If you would like a postmark on
For an additional fee,and with a proper this Certified Mail receipt,please present your
endorsement on the mailpiece,you may request Certified Mail item at a Post Office'"for
the following services: postmarking.If you don't need a postmark on this
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of delivery(including the recipient's signature). of this label,affix it to the mailpiece,apply
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electronic version.For a hardcopy return receipt,
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'C Farm 3800.Aarii Sm s'Rai/arca)PSN 7s'n-m-nnn-anal

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner: 0- r t,6 A '-i -- c.,
Address of Property: / t 7 ( 5 S%' S u,2F c t T-L-1 /'c_ d k-(4
(Lot or Street#, Street or Road, City&County)
Agent's Name#: i 2`'55 - /1'1r`x2 ' tailing Address: (6 6G3' U 5 &"-'`( (7
Agent's phone#: q( � a za 3, 3 t-t- f ,-D n1L e?r--R y 4 r3
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.
If you have objections to what is 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 athttp://www.nccoastalmanagement.net/web/cm/staff-listing 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, boat ramp, breakwater, boathouse, or lift 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.
(PropertyQOwner Informati n) (Riparian Property Owner Information)
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A receipt(this portion of the Certified Mail lay). form electronic return receipt,see a retail
A unique identifier for your mailpiece. associate far assistance.To receive a duplicate
i Electronic verification of delivery or attempted return receipt for no additional fee,present this
delivery. USPS®-postmarked Certified Mail receipt to the
A record of delivery(including the recipient's retail associate.
signature)that is retained by the Postal Service" Restricted delivery service,which provides
for a specified period, delivery to the addressee specified by name,or
to the addressee's authorized agent.
rpportantReminders: -Adult signature service,which requires the
1 You may purchase Certified Mail service with signee to be at least 21 years of age(not
First-Class Mail®,First-Class Package Service®, available at retail).
or Priority Mail®service. -Adult signature restricted delivery service,which
Certified Mail service is notavailabie for requires the signee to be at least 21 years of agr
international mail. and provides delivery to the addressee specified
Insurance coverage Is notavailabie for purchase by name,or to the addressee's authorized agent
with Certified Mail service.However,the purchase (not available at retail).
of Certified Mail service does not change the ■To ensure that your Certified Mail receipt is
insurance coverage automatically included with accepted as legal proof of mailing,it should bear a
certain Priority Mail items. USPS postmark.if you would like a postmark on
I For an additional fee,and with a proper this Certified Mail receipt,please present your
endorsement on the mailpiece,you may request Certified Mail item at a Post Office-for
the following services: postmarking.If you don't need a postmark on this
-Return receipt service,which provides a record Certified Mail receipt,detach the barcoded portion
of delivery(including the recipient's signature). of this label,affix it to the mailpiece,apply
You can request a hardcopy return receipt or an appropriate postage,and deposit the mailpiece.
electronic version.For a hardcopy return receipt,
complete PS Form 3811,Domestic Return
Receipt attach PS Form 3811 to your mailpiece; IMPORTANT.Save this receipt for your records.
s Form 3800.Anril ams iaatmrcni PAN 7can-ro.nnn-an47

ROY COOPER
:e1' --Z' (rovernur
Q
MICHAEL S. REGAN
Secretary
BRAXTON DAVIS
Director
May 10, 2019
Wilba Jean Lee
4908 Lee Drive
Garner, NC 27529
Dear Ms. Lee,
Attached is CAMA Minor Development Permit SC 19-19 for work to be done at 1017 15t Street, in Surf
City, Onslow County. An electronic copy has been sent to the Surf City Inspections Department and your
Agent.
To validate this permit, please sign both copies as indicated for our records. Retain the orange copy for
your files, and return the white copy to us within 20 days of receipt in the enclosed,self-addressed
envelope.
This is not a valid permit until it is signed and returned to our office.
Thank you for your prompt attention to this matter.
e
Si cerely,
Ta ya 'etila
----Permit Support Technician
N.C. Division of Coastal Management
Enclosures
Cc: WIRO files
SC Inspection Dept
Tom Russell—Agent
State of North Carolina Environmental Quality j Coastal Management
127 Cardinal Drive Ext.,Wilmington,NC 28405
919 796 7215

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P.O.BOX 778,BEULAALLE,N.C.28518 III
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I

U.S. DEPARTMENT OF HOMELAND SECURITY OMB No 1660-0008
Federal Emergency Management Agency Expiration Date: November 30,2018
National Flood Insurance Program
ELEVATION CERTIFICATE
Important: Follow the instructions on pages 1-9.
Copy all pages of this Elevation Certificate and all attachments for(1)community official, (2)insurance agent/company, and (3)building owner.
SECTION A—PROPERTY INFORMATION FOR INSURANCE COMPANY USE
Al. Building Owner's Name Policy Number
Lee Collins
A2. Building Street Address(including Apt., Unit, Suite,and/or Bldg. No.)or P.O. Route and Company NAIC Number
Box No.
1017 1st Street
City State ZIP Code
Surf City North Carolina 28445
A3. Property Description(Lot and Block Numbers,Tax Parcel Number, Legal Description,etc.)
Lot 2, Block 46, Extension to Section 3, Old Settlers Beach
A4. Building Use(e.g., Residential, Non-Residential,Addition,Accessory,etc.) Residential
A5. Latitude/Longitude: Lat.34-26-38.5 Long.77-31-09.8 Horizontal Datum: ❑ NAD 1927 ❑x NAD 1983
A6, Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance.
A7. Building Diagram Number 5
A8. For a building with a crawlspace or enclosure(s)
a) Square footage of crawlspace or enclosure(s) 0 sq ft
b) Number of permanent flood openings in the crawlspace or enclosure(s)within 1.0 foot above adjacent grade 0
c) Total net area of flood openings in AB.b 0 sq in
d) Engineered flood openings? ❑ Yes E1 No
A9. For a building with an attached garage:
a) Square footage of attached garage 0 sq ft
b) Number of permanent flood openings in the attached garage within 1.0 foot above adjacent grade 0
c) Total net area of flood openings in A9.b 0 sq in
d) Engineered flood openings? ❑Yes ❑ No
SECTION B—FLOOD INSURANCE RATE MAP(FIRM) INFORMATION
B1. NFIP Community Name&Community Number 62. County Name B3 State
Town of Surf City 370186 Onslow North Carolina
B4. Map/Panel B5. Suffix B6. FIRM Index B7. FIRM Panel B8. Flood Zone(s) B9. Base Flood Elevation(s)
Number Date Effective/ (Zone AO, use Base
Revised Date Flood Depth)
3720424500 K 02/16/2007 02/16/2007 VE 11.0
B10. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in Item B9:
E FIS Profile ❑x FIRM E. Community Determined ❑ Other/Source:
B11. Indicate elevation datum used for BFE in Item B9: ❑ NGVD 1929 NAVD 1988 ❑ Other/Source: 0tttt,l 11. 1ii_/��
v 70 H ,'C c O�frii
ig2. Is the building located in a Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area�R$ ? sr n J1"�2• V'.
Designation Date: ❑ CBRS ❑ OPA = `4 SEAL 'r.
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OMB No. 1660-0008
ELEVATION CERTIFICATE Expiration Date: November 30, 2018
IMPORTANT: In these spaces,copy the corresponding information from Section A. FOR INSURANCE COMPANY USE
Building Street Address(including Apt., Unit, Suite, and/or Bldg. No.)or P.O. Route and Box No. Policy Number:
1017 1st Street
City State ZIP Code Company NAIC Number
Surf City North Carolina 28445
SECTION C—BUILDING ELEVATION INFORMATION(SURVEY REQUIRED)
Cl. Building elevations are based orr 0 Construction Drawings* r-i Building Under Construction* ❑ Finished Construction
*A new Elevation Certificate will be required when construction of the building is complete.
C2. Elevations—Zones A1—A30.AE,AH,A(with BFE),VE,V1—V30,V(with BFE),AR,AR/A,AR/AE,AR/A1—A30, AR/AH,AR/A0.
Complete Items C2.a—h below according to the building diagram specified in Item A7. In Puerto Rico only,enter meters.
Benchmark Utilized: NCGS RTK network Vertical Datum: NAVD 1988
Indicate elevation datum used for the elevations in items a)through h)below.
NGVD 1929 0 NAVD 1988 ❑ Other/Source:
Datum used for building elevations must be the same as that used for the BFE.
Check the measurement used.
a) Top of bottom floor(including basement, crawlspace, or enclosure floor) 13. 8 0 feet ❑ meters
b) Top of the next higher floor n/a. 0 feet ❑ meters
c) Bottom of the lowest horizontal structural member(V Zones only) 12. 1 0 feet ❑meters
d) Attached garage(top of slab) n/a. 0 feet ❑ meters
e) Lowest elevation of machinery or equipment servicing the building 11. 1 0 feet ❑ meters
(Describe type of equipment and location in Comments)
f) Lowest adjacent(finished)grade next to building(LAG) 2. 2 0 feet ❑ meters
g) Highest adjacent(finished)grade next to building(HAG) 2.4 0 feet ❑ meters
h) Lowest adjacent grade at lowest elevation of deck or stairs, including 2. 2 0 feet ❑ meters
structural support
SECTION D—SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION
This certification is to be signed and sealed by a land surveyor,engineer, or architect authorized by law to certify elevation information.
I certify that the information on this Certificate represents my best efforts to interpret the data available. I understand that any false
statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001.
Were latitude and longitude in Section A provided by a licensed land surveyor? El Yes ❑No ❑Check here if attachments.
Certifier's Name License Number
tltill/to
Johnny J.Williams L-3170 \\\\N CA 0////
Title �`�„' 4 •S3 4`/ //��
Professional Land Surveyor $ © � f • y
Company Name = o tteAL =
Johnny J. Williams Land Surveying, P.C. _ 9
Here
Address vD 4•.0 1',*".
P.O. Box 778 % y .'\>P
City State ZIP Code goic //Yitl W,�\\\\
Beulaville North Carolina 28518
Si re Date Telephone
o3 )2.ti 11 1 03/21/2019 [phone]
Copy I ag of this Elevation Certificate and all attachments for(1)community official,(2)insurance agent/company, and(3)building owner.
Comments(including type of equipment and location, per C2(e), if applicable)
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OMB No. 1660-0008
ELEVATION CERTIFICATE Expiration Date November 30,2018
IMPORTANT: In these spaces,copy the corresponding information from Section A. FOR INSURANCE COMPANY USE
Building Street Address(including Apt., Unit, Suite, and/or Bldg. No.)or P.0 Route and Box No. Policy Number:
1017 1st Street
City State ZIP Code Company NAIC Number
Surf City North Carolina 28445
SECTION E—BUILDING ELEVATION INFORMATION(SURVEY NOT REQUIRED)
FOR ZONE AO AND ZONE A(WITHOUT BFE)
For Zones AO and A(without BFE), complete Items El—E5. If the Certificate is intended to support a LOMA or LOMR-F request,
complete Sections A, Band C. For Items El—E4, use natural grade, if available. Check the measurement used. In Puerto Rico only,
enter meters
El. Provide elevation information for the following and check the appropriate boxes to show whether the elevation is above or below
the highest adjacent grade(HAG)and the lowest adjacent grade(LAG).
a) Top of bottom floor(including basement,
crawlspace, or enclosure)is ❑feet IJ meters ❑ above or H below the HAG.
b) Top of bottom floor(including basement,
crawlspace, or enclosure)is ❑feet E meters ❑above or ❑below the LAG.
E2. For Building Diagrams 6-9 with permanent flood openings provided in Section A Items 8 and/or 9(see pages 1-2 of Instructions),
the next higher floor(elevation C2.b in
the diagrams)of the building is feet ❑meters ❑above or ❑below the HAG.
E3. Attached garage(top of slab)is r feet ❑meters ❑above or ❑below the HAG.
E4 Top of platform of machinery and/or equipment
servicing the building is _feet ❑meters H above or ❑below the HAG.
E5. Zone AO only: If no flood depth number is available, is the top of the bottom floor elevated in accordance with the community's
floodplain management ordinance? ❑ Yes ❑ No ❑ Unknown. The local official must certify this information in Section G.
SECTION F—PROPERTY OWNER(OR OWNER'S REPRESENTATIVE)CERTIFICATION
The property owner or owners authorized representative who completes Sections A, B,and E for Zone A(without a FEMA-issued or
community-issued BFE)or Zone AO must sign here. The statements in Sections A, B, and E are correct to the best of my knowledge.
Property Owner or Owner's Authorized Representative's Name
Address City State ZIP Code
Signature Date Telephone
Comments
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❑Check here if attachments.

OMB No. 1660-0008
ELEVATION CERTIFICATE Expiration Date: November 30,2018
IMPORTANT: In these spaces,copy the corresponding information from Section A. FOR INSURANCE COMPANY USE
Building Street Address(including Apt., Unit, Suite, and/or Bldg. No.)or P.O. Route and Box No. Policy Number:
1017 1st Street
City State ZIP Code Company NAIC Number
Surf City North Carolina 28445
SECTION G—COMMUNITY INFORMATION(OPTIONAL)
The local official who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete
Sections A, B,C(or E), and G of this Elevation Certificate. Complete the applicable item(s)and sign below. Check the measurement
used in Items G8—G10. In Puerto Rico only,enter meters.
G1. ❑ The information in Section C was taken from other documentation that has been signed and sealed by a licensed surveyor,
engineer,or architect who is authorized by law to certify elevation information. (Indicate the source and date of the elevation
data in the Comments area below.)
G2. ❑ A community official completed Section E for a building located in Zone A(without a FEMA-issued or community-issued BFE)
or Zone AO.
G3 ❑ The following information(Items G4—G10)is provided for community floodplain management purposes.
G4. Permit Number I G5. Date Permit Issued G6. Date Certificate of
Compliance/Occupancy Issued
G7. This permit has been issued for: ❑ New Construction f, Substantial Improvement
G8. Elevation of as-built lowest floor(including basement)
of the building: ❑ feet ❑ meters Datum
G9. BFE or(in Zone AO)depth of flooding at the building site ❑feet ❑ meters Datum
G10. Community's design flood elevation: ❑ feet ❑ meters Datum
Local Official's Name Title
Community Name Telephone
Signature Date
Comments(including type of equipment and location, per C2(e), if applicable)
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BUILDING PHOTOGRAPHS OMB No 1660-0008
ELEVATION CERTIFICATE See Instructions for Item A6. Expiration Date. November 30, 2018
IMPORTANT: In these spaces,copy the corresponding information from Section A. FOR INSURANCE COMPANY USE
Building Street Address(including Apt., Unit.. Suite,and/or Bldg. No.)or P.O. Route and Box No. Policy Number:
1017 1st Street
City State ZIP Code Company NAIC Number
Surf City North Carolina 28445
If using the Elevation Certificate to obtain NFIP flood insurance, affix at least 2 building photographs below according to the
instructions for Item A6. Identify all photographs with date taken; "Front View"and"Rear View"; and, if required, "Right Side View"and
"Left Side View." When applicable, photographs must show the foundation with representative examples of the flood openings or
vents, as indicated in Section A8. If submitting more photographs than will fit on this page, use the Continuation Page.
Photo One
Photo One
Photo One Caption
Photo Two
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Photo Two
Photo Two Caption

•
BUILDING PHOTOGRAPHS OMB No 1660-0008
ELEVATION CERTIFICATE Continuation Page Expiration Date: November 30, 2018
IMPORTANT:In these spaces,copy the corresponding information from Section A. FOR INSURANCE COMPANY USE
Building Street Address(including Apt., Unit, Suite, and/or Bldg. No.)or P.O. Route and Box No. Policy Number
1017 1st Street
City State ZIP Code Company NAIC Number
Surf City North Carolina 28445
If submitting more photographs than will fit on the preceding page, affix the additional photographs below. Identify all photographs
with: date taken; "Front View" and "Rear View and, if required, "Right Side View" and "Left Side View." When applicable,
photographs must show the foundation with representative examples of the flood openings or vents, as indicated in Section A8.
Photo One
Photo One
Photo One Caption
Photo Two
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Photo Two Caption
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li.1:1 NC Division of Coastal Management
Cashier's Official Receipt 8211. A B Ci
Date: 20 0 ' `
Received From: '&1A" `t t.--(orita______
$ /ev)g
Permit No.: _P; ) Check No.:
Applicant's Name: !! (''/ d J2cT1 County: t lr
Project Address: / 0/ 7 ;fd , ul
Please retain receipt for your records as proof of payment for permit issued.
Signature of Agent or Applicant: Date:
'
Signature of Field Representative. Date:

Date Date Check From Name of Vendor Check Check Permit Rct.
Received Deposited Permit Holder Number amount Number/Comments
4/22/2019 `Future Homes, Live Wilba Jean Lee BB&T 40659 $100.00 minor fee, 1017 1st Street,Surf JD rct.
Oak Ent, Inc. City OnCo 8211