TB_21-06_ Gorman (2)

c 3
Issued by WiRO RECEIVED TB2I.06
Permit Number
Topsail Beach MAY 1 0 2021
LAMA -y„M
CM WILMINGTON,
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 Jackie Gorman authorizing development in the Estuarine Shoreline Area of Environmental Concern (AEC) at
1214 Carolina Boulevard, in Topsail Beach, Pender County as requested in the permittee's application dated April 5,
2021, and received by DCM on April 15, 2021. This permit, issued on May 1, 2021, is subject to compliance with the
application and site details (where consistent with the permit), all applicable regulations and special conditions and notes
set forth below. Any violation of these terms may subject permittee to a fine, imprisonment or civil action, or may cause
the permit to be null and void.
This permit authorizes: Demolition of existing residence and clearing/grading of lot.
(1) All proposed development and associated construction must be done in accordance with the application package dated
received by the Division of Coastal Management on April 15, 2021. This permit does not authorize the creation of any new
structures. Future development activities on the subject property will require re-evaluation by DCM.
(2) All construction must conform to the N.C. Building Code requirements and all other local, State and Federal regulations,
applicable local ordinances and FEMA Flood Regulations.
(3) Any change or changes in the plans for development, construction, or land use activities will require a re-evaluation and
modification of this permit.
(4) A copy of this permit shall be posted or available on site. Contact this office at [phone] 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 Jason Dail
site and accessible to the permit officer when the project is inspected for CAMA Local Permit Officer
compliance. Any maintenance work or project modification not covered under 127 Cardinal Drive Extension
this permit,require further written permit approval.All work must cease when this
permit expires on: Wilmington, NC 28405-3845
December 31,2024
In issuing this permit it is agreed that this project is consistent with the local Land

Name: Jackie Gorman
Minor Permit#TB21-06
Date Issued: May 1, 2021
Page 2
(5) 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.
(6) Any proposed for grading within the 30' buffer 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 vegetatively
stabilized, and must remain in a vegetated state.
(7) No structures shall be located within the 30' Coastal Shoreline buffer.
(8) This permit does not authorize the excavation or filling of any wetlands or open water areas.
(9) 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 S t2a-' 41 � DATE:
PERMITTEE
ri'

y d 01 f_ cLU .,told_ Pettit Nutubea I 2 OTHER PERMITS MAY BE REQUIRED:The activity you are planning may require permits older than the LAMA
1 minor development permit,including,but not limited to:Drinking Water Well,Septic Tank(or other sanitary waste
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.
RAL INFORMATION
STATEMENT OP OWNERSHIP:
OWNER-MAILING ADDRESS 1,the undersigned,an applicant fur u CAMA minor development permit,being tither the owner of property in an AEC or a
person authorized to act as an agent for purposes of applying fir a CAMA minor development permit,certify that the person
j�e�f r G-C T t Q'r listed as landowner on this application has a significant interest in the real property described therein.This interest can be
3-1_43 oid J re,,,IT Cs. .t pr _--- �_._. described as:(cheek one)
!lqp O./ /1 i ii Sete A)C Zip (Erie ( 1 125,2 PO Li Li _ an owner or record title,Title is vested in muse of {TO.t tit t,/e le `. Cr-o i �.fn
la- es v.%e ,i 1 I COsee Used Book 76 j page ay in the t; (- County Registry of Deeds.
1 Tb 1I)�'ot�bet
(PRIZED AGENT ___an owner by virtue of inheritance.Applicant is an heir to the estate of
-- ;probate was in County.
— *other interest,such as written contract or lease,explain below or use a separate sheet&attach to this application.
s eat (n4.�/td' Crr-tV __
ftsi-t. )t LLYne. State A)( __-.._. Zip agd/PRun, Q/O_it4 5- 7 4 415 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
She jr ).L v�C.drt r Se.C i_ ,_LC &yrs Qi l r r p Yrs. ACTUAL NOTICE to each of them concerning my intent to develop this property and to apply for a CAMA permit.
(Name) (Addn-ss)
nON OF PROJECT: street name(Address, and/or directions to site;name of the adjacent waterbod �/
n .)Y (1) 3-Q.S4.rk /7 ikgY1,5 IA Its f:-a.Q-411Y1b 1ms EIYi Sn.jl Bea(
1'{ Cot-tcl:r� l�j IJJ (2) aiarl� .2,. G„tr.r 1-413.. <..e.> li ingt a1tr.S0 —revccul «c.y.._
li)ScI,;1 s3..,,,,h 0 A c 2'/43 (4) --- -- ----
OPTION OF PROJECT:(List all proposed construction and land disturbance.) )C4 (Z r.[ *Icy ACKNOWLEDGEMENTS:
I.the undersigned,acknowledge that the land owner is aware that the proposed development is planned tut an area which
b c,-se ) Cn nS+(-d G't-_A k,-u,) 14t,Thy j ' yser t� 5-tare t may be susceptible to erosion and/or flooding.I acknowledge that the Local Permit Officer has explained to me the particu-
d . tar hazard problems associated with this lot.This explanation was accompanied by recommendations concerning stabilize-
*LOT/PARCEL.: fpA�© square feet /6 acres 1'� � lion and floodproofmg techniques.
JSED USE:Residential( (Single-family"Multi-family 0) Commercial/Industrial 0 Other 0 I twthermore certify that 1 am authorized to grunt,and du 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
'LETS EITHER(I)OR(2)BELOW(Contact your Local Permit Officer if you are net slue which AEC applies related to this permit application.
prvperryl: ',Pt
This the day©f4 f /,20 at
:EAN HAZARD AEC*:TOTAL FLOOR AREA OF PROPOSED STRUCTURE: square feet(includes _ TT
Mitioned living space.parking elevated above ground level,non-conditioned space elevated above ground level but .�
rig rho-load-bearing attic space) ner or person riucd to act as h- r agent for purpose of filing a CAMA permit application
IASTAL SHORELINE AEC,:SIZE OF BUILDING FOOTPRINT AND OTHER IMPERVIOUS OR BUILT
This application includes:general fnforntutio.n(this*sit),a site drawing as described on the back of this application,the
SURFACES/,Agsyuare feet(includes the area of the foundation of all buildings,driveways,covered decks, ownership statement,the(hewn Hazard AEC Notice where necessary a cheek Jar$100.00 made payable to the locality,and
e or masutuy patios,etc.that are within the applicable AEC.Attach your calculations with the project drawing.)
any information as may be provided orally by the applicant.The details of the application as described by these sowves are
STORMWATER MANAGEMENT PERMIT:Is the project located in an area subject to a State incorporated without reference in arty permit which may he issued.Deviation from these details will constitute a relation of
rater Management Permit issued by the NC Division of Energy,Mineral and Land Resources(DEMLR)? any peanut.Any person developing in an AEC'without permit is saOrcv to cavil.criminal and adminiaarutire ac lion.
NO tf
tat the total built upon area/impervious surface allowed fur your lot or p-ar rl: square feet.

0EST
ROY COOPER
Governor _ hi
DIONNE DELLI-GATTIert a;,
Secretary '�4a, , •.;,>::
BRAXTON DAVIS NORTH CAROLINA
Director Environmental Quality
May 3, 2021
Jackie Gorman
143 Old Forest Creek Drive
Chapel Hill, NC 27514
Dear Ms. Gorman,
Attached is CAMA Minor Development Permit TB 21-06 for work to be done at 1214 Carolina Boulevard
in Topsail Beach, Pender County. An electronic copy has been sent to the Topsail Beach Inspections
Department and to your, Agent.
To validate this permit, please sign both copies as indicated for our records. Retain the gold 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.
Sincerely,
Anita M.Webb
Permit Support Technician
N.C. Division of Coastal Management
Enclosures
Cc: WiRO files
TB Inspection Dept.
Peter Hedrick Shelby Contracting-Agent

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1 }OS 8/8 PHYSICAL SURVEY
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LOT 7 BLOCK 30
t NEW TOPSAIL BEACH
1 PREPARED FOR
' JACQUELENE W. GORMAN
TOPSAIL.TOWNSHIP. PENOER COUNTY, NC
PREPARED 87
THIS IS 10 CERTIFY THAT DOS NAP IS A TRUE JQHN L. PIERCE & ASSOCIATES. P.A.
REPRESENTATION OF THE PROPERTY HEREON AS
CONKED NY ACTUAL SURVEY OF THE PREUPSES NORTH CAROUNA U(ENSE N0. C-1888
AND THAT THERE ARE NO EHCROAOIADOS ACCORO-. 1111 HIT
NC TO THE BEST OF Nv NN0904IE,EXCEPT AS 11t T4 409 JOHNSON BLVD. JAOCSONVILL,E, NC 28540
SHOWN THE RA110 OF PRECISION IS 1,14000+. •`,0H CASE,, ,,� PHONE: [phone] DATE: JULY 14, 2017
`P:'gSBi",of (�yy'- SCALE: 1-- 40' F.B. 903,PG. 84
=�le ' s JOB/2017-254
ALA. i Z. GRAPHIC SCALE
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J01Nt"'PENCE.PL3.,L-2586 t:,t OI 4,7 ADORES!, 40 0 20 40 80 160
REFERENCES: MIN MI IIMMIIM 11111111111.
1.�,V... p.....,Z. 1214 CAROJPIA BLVO. NO — M (OE SW)
NEmNs
08:2761,PC:24 i.11....r,l`'‘` E lash 4. 40 R

JOHN L. PIERCE & ASSOCIATES,P.A.
LAND SURVEYING LAND PLANNING MAPPING
P.O.BOX 1685
..6r 405 JOHNSON BLVD.
JACKSONVLLE,NC 28541
OFFICE:910-346-9800 FAX:[phone]
E-MAIL [e-mail]
yrjanjOilanc.com
r JACQUELENE GORMAN
GENERAL DELIVERY
TOPSAIL BEACH,NC 28445
L
JOB#2017-254-BOUNDARY,TOPOGRAPHIC AND
PHYSICAL SURVEY,PREPARE BOUNDARY AND
TOPOGRAPHIC SURVEY MAP AND A PHYSICAL
SURVEY MAP WITH SURVEYOR'S REPORT&FLOOD
CERTIFICATE FOR LOT 7 NEW TOPSAIL BEACH
$860.00
ACCOUNTS NOT PAID WITHIN 30 DAYS ARE SUBJECT TO A
SERVICE CHARGE OF 1 S %PER MONTH ON UNPAID BALANCE
EFFECTIVE ANNUAL RATE OF INTREST-18%

JOHN L. PIERCE & ASSOCIATES, P.A.
a4. LAND SURVEYING•LAND PLANNING•MAPPING 4•�
■.. C.. •.(..C..
OFFICE:910-346-9800
- FAX:[phone]
E-MAIL:bettybajlpnc.com
P.Q.Box 1685 or [e-mail] 405 Johnson Blvd.
Jacksonville,NC 28541 Jacksonville,NC 28540
FLOOD CERTIFICATION
Date: July 14,2017
TO WHOM IT MAY CONCERN:
Re: Property Address: Lot 7 Block 30 New Topsail Beach
1214 Carolina Blvd.
(RE:MB;3 PG:72,DB:2761 PG:24)
BORROWER(S): Jacquelene W.Gorman
The above referenced property is located in Zone AE 11 as determined by the
Director of the Federal Emergency Management Agency as shown on the FEMA
Map No. 370187-4212 J dated 2/16/2007 which indicates the
property (X) is ( ) is not located in a Special Flood Hazard Area. A`OjIT H C 1,
JOHN L.PIERCE&ASSOC ITE IFE 4>0
/0% r
Z
JOHN L. IERCE,P.L.s •• 6 „••
41 • Ms
is yyISO4 y
LOTS,FARMLAND AND WOODLAND SURVEYING•SITE PLANNING•SUBDIVISION LAYOUT•LAND DEVELOPMENT PLANNING
CONSTRUCTION SURVEYING•TOPOGRAPHIC SURVEYING AND MAPPING
Phase I Errvtronmentai Audit I Risk Assessment

l'orn,No.I i 2 +O1'F=R i
erInvestors Title Insurance Company
� A Stock Company
P.Q.Drawer 2687
Chapel Hill,North Carolina 27515-2687
[phone] [phone] Fax:[phone]
SURVEY INSTRUCTIONS AND CERTIFICATE
A survey to be acceptable to INVESTORS TITLE INSURANCE COMPANY must be prepared in U.S. Standard of measurements
and if within corporate limits of any town,village or city,must be a"transit"survey and not a"compass"survey. Preference will
always be given to surveys showing bearings referred to true north but all surveys which show bearings must designate the meridian
referred to whether true,magnetic or arbitrary and if true meridian is not used,approximate deflection must be noted on plat.
Boundaries 1.Every survey,whether of farm or city property must indicate the physical character of the boundary
lines,that is,whether fence,wall,water-course,highway etc.,and if no physical evidence of boundaries
exists,such fact must be noted. Any material variations from the record lines by fences,walls,structures,
whether on the property surveyed or adjoining,must be shown,with the extent of such variations. If any of
the boundaries or lines of record coincide with lot or property lines on any filed map,or are adopted from
previous surveys,whether by the same surveyors or otherwise,such facts should be shown on the plat. The
surveyor is required to check the descriptions of adjoining owners,when furnished to him,and show the
extent of any variations between the boundaries as stated therein and those of the property surveyed.
Rights of Way, 2. The surveyor must indicate any water courses,drains,sewers,utility easements;joint cemeteries,
Cemeteries,etc. driveways,roads.paths or trails crossing the property the closing of which might affect the rights etc.of
adjoining owners,whether legal or assumed. He must also show any existing cemetery or burying grounds
on surveyed property
Streets and Alleys 3. Names of streets and alleys must be shown with the distance from the nearest corner to beginning point
of property surveyed. Width of street and sidewalk in front or at side of premises should be shown with
width of alley in rear or side of premises.
Party Walls 4. The nature,character,location and width of all walls on or near boundary lines should be shown. Show
all projections beyond face of wall and indicate the portion of wall on the property and the portion on
adjoining property and whether subject to beam rights. The thickness of walls throughout entire length s
hould be shown. If building on premises has no independent wall but uses any wall of adjoining premises,
this condition should be shown and explained. The same requirements apply where conditions are
reversed.
Adjoining Ownders 5. Indicate on survey the names of adjoining owners on all sides of the premises which information may be
and Lot Numbers obtained from occupants. Lot numbers of the property in question and of adjoining lots must be shown.
Encroachments 6. Encroachments of buildings and of structural appurtenances,such as fire escapes,bay windows,etc.,by
or on adjoining property or on abutting streets,must be indicated with the extent of such encroachments.
Building and Lot 7. All buildings on property must be shown with dimensions and relation to lot and building lines. If
Lines conditions in chain of title or zoning ordinances require building to be set back specified distances from
street or property line survey must show measured distances from said building to said line. In acreage
surveys buildings may be plotted to scaled positions.
Area 8. Show acreage of the property except in cases of small lots.
Contiguity 9. If survey comprises several parcels,show interior lines and facts sufficient to insure contiguity. We
should be furnished with a consolidated description. Caution should be used to see that there are no strips
or gores.
Courses and 10. Courses and distances should be properly denoted,showing stakes or other monumentations appearing
Distances on the premises. Map should show arrow pointing north and give scale of distances.
1 I. All maps must show City or Town and State where premises located with such other notations as will
accurately identify property surveyed. The certificate thereon must be dated as of date survey was made,
signed by surveyor,and be to the effect that the survey was actually made on the ground as per record
description and is correct;that there are no encroachments either way across property Ii nes except as
shown.
The certificate should be addressed,to-wit: "To all parties interested in title to premises surveyed"
In addition to the certified map of the survey we require the report to be filled out by the surveyor on the
"SURVEYOR'S REPORT"on the reverse side of this form.

cr, Investors Tale Insurance Company
A Stock Company
P.O.Drawer 2687
Chapel Hill,North Carolina 27515-2687
[phone] [phone] Fax:[phone]
SURVEYOR'S REPORT FORM
To:INVESTORS TITLE INSURANCE COMPANY
THIS IS TO CERTIFY,that on July 14,2017 ,I made an accurate survey of the
premises standing in the name of Jacquelene W.Gorman
Topsail Twp. Pender North Carolina
CITE COUNTY STATE
situated at briefly described as Lot 7 Block 30 New Topsail Beach(RE:MB:3,PG:72;DB:2761 PG:24)
and shown on the accompanying survey entitled: Physical Survey
I made a careful inspection of said premises and of the buildings located thereon at the time of making
such survey and again on July 14.2017 and at the time of such latter inspection I found
Jacquelene W.Gorman to be in possession of said premises as Buyer
(TENANT)OR(OWNER)
I further certify as to the existence or non-existence of the following at the time of my last inspection:
1. Rights of way,old highways,or abandoned roads,lanes or driveways,drains,
sewer,water,gas or oil pipe lines across said premises: None apparent
2. Springs,streams,rivers,ponds,or lakes located,bordering on or running
through said premises: Intercoastal waterway
borders said lot.(SEE ATTACHED MAP)
3. Cemeteries or family burying grounds located on said premises. (Show
location on plat): None apparent
4. Telephone,telegraph or electric power poles,wires or lines overhanging or
crossing or located on said premises and serving said premises or other
property or properties: None apparent
5. Joint driveways or walkways;party walls or rights of support,porches,steps
or roofs used in common or joint garages: None apparent
6. Encroachments,or overhanging projections(If the buildings,projections or
cornices thereof,or signs affixed thereto,fences or other indications of
occupancy encroach upon or overhang adjoining properties,or the like
encroach upon or overhang surveyed premises,specify all such): Fence belonging to now or
formerly Jason Michael Adams has a tie on encroachment with said lot.(SEE A 1 1-1 ACHED MAP)
7. Building or possession lines. (In case of city or town property specify
definitely as to whether or not walls are independent walls or party walls and
as to all easements of support or"beam rights". In case of country property
report specifically how boundary lines are evidenced,that is,whether by
fences or otherwise). None apparent
8. Is property improved? Yes
9. Indications of building construction,alterations or repairs within recent
months:
(a)If new improvements under construction,how far have they progressed? Normal Maintenance
10. Changes in street lines either completed or officially proposed:
(a)Are there indications of recent street or sidewalk construction or repairs? No
11. Does the property abut a dedicated public road?If not,explain what type of
road it abuts. If property does not abut a road,answer this question"none'. \` 4ttigi,t.`
12. If the surveyed premises are subject to restrictive covenants,do the \\\ H 49��,
improvements,use and occupancy comply with such?(If the premises are pFESs'•,•O
subject to restrictive covenants,have the examining attorney furnish you `fo he 6lermine y *ley
verbatim copy of them.) _ S Y:
•
�4C
1.
p L-2$s�
John L. e, .L. �•j. VRVE�•' �•••
NOTE: In all cases where there are encroachments,support easements,party walls,etc.,they should also be dtsgted4ipo �p‘' \\
of your survey. Also,be certain map complies with instructions on reverse side. * ' ....... ��\

Dail, Jason
From: Peter Hedrick <[e-mail]>
Sent: Thursday, April 15, 2021 3:06 PM
To: Dail, Jason
Subject: Re: [External] 1214 Carolina Blvd CAMA info
CAUTION: External email. Do not click links or open attachments unless you verify.Send all suspicious email as an attachment to
Report Spam.
Yes Sir
Thank you
On Thu, Apr 15, 2021 at 3:05 PM Dail, Jason <jason.dailncdenr.gov> wrote:
Thank you. Just to confirm,the minor permit being applied for is specific to demolition only.
Jason
Jason Dail
Field Representative
NC Department of Environmental Quality
NC Division of Coastal Management
127 Cardinal Drive Ext.
Wilmington, NC 28405
Phone:[phone], Fax:[phone]
[e-mail]
*E-mail correspondence to and from this address
may be subject to the North Carolina Public
Records Law and may be disclosed to third parties.

From: Peter Hedrick [mailto:[e-mail]]
Sent:Thursday, April 15, 2021 2:56 PM
To: Dail,Jason <[e-mail]>
Subject: [External] 1214 Carolina Blvd CAMA info
CAUTION: External email. Do not click links or open attachments unless you verify.Send all suspicious email as an attachment to
Report Spam.
Jason,
Attached is the certified mail receipt for the other neighbor at 1210 Carolina Blvd.
Thank you,
Linda Hedrick
Peter Hedrick
Shelby Contracting
910-465-2945
Peter Hedrick
Shelby Contracting
.Shelby
Contracting
�_ inc.
910-465-2945

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Large Envelope
Hampstead, NC 28443 PS Form 3800,April 2015 PSN 7333 02-000-9a47 See Fever se for Instruction
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Give Directions $� 40 plope `-'nj Sent`71 e� -----_______
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First-Class Maile 1 0 ;` m Io. �°'t '
Firs 3 .--------------------------Large EnVeRid9 NC 28445 6636. 'ie. ,_ 21y -E}c�oi
Holly 0 l b 2.60 02 �.' S Reverse tar Instructions
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9590 9402 6593 1028 4150 92$7.85
Total _
Grand Total : . ________ __---^_$7.85
Debit Card Remitted
Card Name MasterCard
Account #: 00000 XXXXXX7865
Approval #: 141462
Transaction it: 953
Receipt #: 033417 7 85
Debit Card Purchase: $7.85
AID: A0000000042203
AL: US DEBIT
PIN: Verified ------------------

ADJACENT RIPARIAN PROPERTY OWNER
STATEMENT FOR CAMA MINOR PERMITS
I hereby certify that I own property adjacent to_�.J C�C e o r'rna,. _'s
(Na of Property Miner)
property located at 1 La..r t? 1 t hick- t j .
Address,Lot, B ock oad a c.)
.fiLI: Z,A\" 1on sc ,wr�e ,in 1O S (L.; 1 peke_h 'P J CrN.C.
(Waterbody) (-Sown and/or County)
He has described to me as shown in the attached application and project drawing(s),the development
he is proposing at that location,and, I have no objections to his proposal.
(APPLICATION AND DRAWING OF PROPOSED DEVELOPMENT ATTACHED)
Si re
Ja N e
Print or Type Name
Tel phon Number
Dat

ER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY
nplete items 1 , 2, and 3. i %nature L f . i
It your name and address on the reverse '
that we
can return the card to you. &IN(..... Lach this card to the back of the mailpiece, B. R=- .ived by (Pri d Nv2e) C. D
)n the front if space permits. 44 s. - t•I‘ �..
;le Addressed to: D. Is delivery address different fro em 1?
If YES, enter delivery address below: 4
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3. Service Type 0 Priority t
' 1 I 1 0 Adult Signature 0 Register
I 0 Adult Signature Restricted Delivery 0 Register
0 Certified Mail® Delivery
9590 9402 6593 1028 4150 93 ❑ Certified Mail Restricted Delivery 0 Signatur
0 Collect on Delivery 0 Signatur
_c_ La-_.,—L -- rrhoev ,rkfe+r_frnrr,. eltirtiltNa1. .hall..__ 0 Collect on Delivery Restricted Delivery Restrict(
DAD 0640 0002 2348 4859 ed Mail
ed Mall Restricted Delivery
,�. — $5OMM
rm 3811 , duly 2020 PSN 7530-02-000-9053 Domestic F

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[lily PertnitNumber OTHER PERMITS MAY BE RED] O O 0_ a
minor development permit,including. 13 z
to Hazard hstnarine Shoreline_ORW Shoreline Public Trust Shoreline Other treatment system),Building,Flectricr m co ro co
(For official use only) Certification,Sand Dune,Sediment C a g •• 0others.Check with your Local Permit I/
(p O
QERAL INFORMATION STATEMENT OF OWNERSHIP: - D '
ID OWNER-MAILING ADDRESS I,the undersigned,an applicant for a r tmi+ o
person authorized to act es au agent II n 5. ��.
IC_ 1A-S-Hw 1 n` C'� T 'V listed as landowner on this applicant); w al w
VVVVVt LL,, �e r� — described as (check one) = N
rasa_ ! 7 3 dt f G�-r�� 6- .IA p{_ < m
Chap i M ` C 1 ' 4 Z� 7 96 is L• en owner or record title,Title is - 2 _
// State �1(— ZiP one Ar
` ` see Deed Book i7�i/ �` \z 5'
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IHORIZED AGENT (� -.4 _an owner by virtue of inheritana ,Iiik* m .
me Tct�t- liedirlcK CS/nethy CeU—tPme..+,k_rc 1 1 -5 �- 1 �
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_Tif other interest,such as written
tress &o f t��1-�/t tJ" `-E 2 _,, ID
r G�—! y /(i C Zip gd Pff-9 Cri .965..27 9 S NOTIFICATION OF ADJACENT' O (n
q$}ALL/17e State _ , sue dl furthermore certify that the fallowit '�
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ail S�r_i t/CO T�r cs C,} ' 'QI 1 L> cal • F;0 Yh ACTUAL NOTICE to each of them 0 �- \ —%
JJ O �_
(Name) O to
CATION OF PROJECT:(Address,street name and/or directions to site;name of the adjacent wsterbody.) (I) .,r a TN A ern Q O
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SCRIPTION OF PROJECT:(Lib(all proposed construction and land disturbance.) G O eN, ACKNOWLEDGEMENTS: O 33
(D
I.the undersigned.acknowledge that �� 0
�00Se ' �rS,ITL)Ct AkL.) Ho The ) S�y�1e -5-/F- ?Cs may besusceptbleto erosion and/or !v �.
A 1 I,{5 •
t, tar hanud problems associated with! 3 �_� -0
GE OF LOT/PARCEL: �7S�© aqunre feet /G acres non and itoodpraofing techniques.
IOPOSED USE:Residential Nk (Single•family wr Multi-family a) Commercial/industrial a Other 0 I furthermore certify that I am author p
the Local Permit Officer and their ag
)MPLETE EITHER(I)OR(2)BELOW Contactyour Local Permit Officer i you are not sure which AECapplies 13
( J/I 13' related to this permit application. (1)
tour property); -
OCEAN HAZARD AECa:TOTAL FLOOR AREA OF PROPOSED STRUCTURE: square feet(includes C) C)
(m
conditioned living space.parking elevated above ground level,non-conditioned space elevated above ground level but � C N
� n 0
:luting non-load-hearing attic space) Lira ter or person ri ted'to a C tZ ' ark
Z
COASTAL SHORELINE AECa:SIZE OF BUILDING FOOTPRINT AND OTHER IMPERVIOUS OR BUILT This application includes:general O
ON SURFACES/,2 square feet(includes the area of the foundation of all buildings,driveways,covered decks, ownership ltl. a statement,the Ocean 0 0 /\ (-
mete or masonry patios,etc. are within the applicable AEC.Attach your calculations with the project drawing.) re Cu
any information as may be provide - "�
without reference in a t
'ATE STORMWATER MANAGEMENT PERMIT Is the project located in an area subject to a State incorporated _ • C
urmwater Management Permit issued by the NC Division of Energy,Mineral and Land Resources(DEMLR)? any permit.Airy person developing '�,
ES_______ NO, Y ! ' ` c
yea,list the total built upon area/impervious surface
allowed for your lot or partxl: square feet. 1 y
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0. -03 0
m m >
D o a 15 irk
ality Permit Number OTHER PERMITS MAY BE REQ p p Q N .. -el
minor development permit,including. Z O
ran Hazard- Estuarine Shoreline ORW Shoreline Public Trust Shoreline Other treatment system),Building,EItxtricr N (.0w a) 3
Certification,Sand Dune,Sedbnent C 2 2 N N
(For official ore only)
others.Check with your Local Permit
OD O
JYERAL INFORMATION STATEMENT OF OWNERSHIP: - D
ND OWNER-MAiLING ADDRESS I,the undersigned,an applicant for al
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�a person authorized to act as au agent l p - r,—. r
ore_- 3ctt{Y 1 P p S ttiQ IL _ _—_..------------._--_-.-- —_-----_ listed as landowner on this appllcetiui p) pnj
Idress_-V-, 3 c J to rcl re ST c i-ee e.K p described as:(check one) D• cc
----...--•-• ih, le . ..\.-C.--\... '
r .Ti! a�y 9d L f_L/ an owner or record title,Title is Fri
y `hQpC�1 N►l1 Slate c ,Zip,_f, nc 1 -�-- (' w
mid /� -{ See Deed Book 76 / ` `-,o a) <-
an owner by virtue of inherimnc n
JTHORIZEDAGF.N7' (D
twee Ter+Qr- -i_lcX Cs_ clk CoPi rm.�-r,`r - _.. vi .�
if other interest,such as written `-. O
Idress &O t C,sh_-#-Nit r C(- — t yk??:::2'...,:,
W
0
L�/ o r NO'1 IFiCATION OF ADJACENT ! (n
ty }l } �y net e State A) Zip S"�Pllou9__Qr�'7i9 S 1 7 S _.- 1 furthermore certify that the followit E � 0*,nail shell L C.mi T-c C.'� (S. t .rRu'•i! r C Q Y1".,.--_---_,__ ACTUAL NOTICE to each of them n/ (Herne) �/ O �'s' \ ODCATION OF PROJECT:(Address,street name andior directions to site:name of the adjacent unterbody.) (I) `_ ' h /`/ el rl i - Q
n N A
l )'-1 Cos-till.._ 1�i uc�l' (2)xstr . G�-�m„+ il-in)
7 Sri l 3cc c h f C y43 (4) _ - (3 �.
O
ESCRIPTION OF PROJECT (List all proposed construction and land disturbance.) �t...1 C e / ACKNOWLEDGEMENTS: O al
..` I.the undersigned.acknowledge that ` N CJ
He(1 x e ► 1 1S f 6�G'i' /t iG W e !s S Y+Ct.k ' *M t may be susceptible to erosion andkn' N V�^ _,
J , - 4� tar hazard problems associated with 3 -
IZE OF LOT/PARCEL: gme�a square feet ►/ acres / non and floodproufing techniques. m
ROPOSED USE:Residential (Single-family ier Multifamily 0) Commercial/Industrial 0 Other 0 I furthermore certify that I am author O
the Local Permit Officer and their ag
OMPLETE EITHER(i)OR(2)BELOW(Contact your Local Permit Officer If you are not stare which AEC applies related to this penny application. fio
your property):
1) OCEAN HAZARD AECs:TOTAL FLOOR AREA OF PROPOSED STRUCTURE:_ square feet(includes _ 1 0 0 En
i conditioned living space,parking elevated above ground level,non-conditioned space elevated above ground level but C (CD)
CI
Wilding non-load-hearing attic space) ad nee or person 'zed to Q c, K w
t) COASTAL SHORELINE AEG:512E OF BUILDING FOOTPRINT AND OTHER IMPERVIOUS OR BUILT This application Includes:general m� 1 O `"
9)OH SURFACES, ;gsquare feet(includes the area of the foundation of all buildings,driveways,covered decks, wnersh i statement,the Ocean - 0 0 \A C
uncrete or masonry patios,etc.that are within the applicable AEC.Attach your calculations with the project drawing.) w any information as may be provided' *
Pi' l\
TATE STORMWATER MANAGEMENT PERMIT:Is the project located in an area subject to a State incorporated without reference in at f, n c
Iturmwater Management Permit issued by the NC Division of Energy,Mineral and Land Resources(DEMLR)? any permit.Any person developing "�-.
S n
(ES NO 17- 1 ` C_
f yes,list the total built upon arcaiimprrvious surface allowed fur your lot or parcel: -square feet.
�g �
11"1. (7,-
\

)ate Date Check From Name of Vendor Check Check Permit Rct. #
:eived Deposited Permit Holder Number amount Number/Comments
/2021 Shelby Contracting, Jason Gorman Bank of 1086 $100.00 Minor fee, 1214 Carolina Blvd, JD rct.
Inc. America Topsail Beach PnCo 13405