05-22 B_Jeff Cline and Susan Yan_20220512

Tyrrell County No. 05-22
DCM Washington Permit Number
District
CAMA
MINOR DEVELOPMENT
PERMIT
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.Jeff_Cline and Susan Yan authorizinq__development in the Estuarine Shoreline (AEC) at 0 Shifting_Sands, Plot I _
T071 07 001, adjacent to the Albemarle Sound in Columbia, Tyrrell County, North Carolina as requested in the
permittee's application, dated 12 May 2022 but received complete on 5 July 2022. This permit, issued on 11 July 2022,
is subject to compliance with the application and site drawing (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: construction of a new 88' x 76' single family residence, located approximately 35'landward the
existing drainage canal as well as the installation of a septic field and the associated grading of±2,500ft2 within the 75'
CAMA AEC. The proposed impervious surfaces within the 75' CAMA AEC is ±2,300ft2 of their allowable±12,200ft2.
(1) All proposed development and associated construction must be done in accordance with the permitted work plat
drawings(s) dated received on 12 May 2022.
(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.
This permit action may be appealed by the permittee or other qualified persons
within twenty(20) days of the issuing date. From the date of an appeal, any
work conducted under this permit must cease until the appeal is resolved.This
permit must be on the project site and accessible to the permit officer when the As ey Grandy
project is inspected for compliance. Any maintenance work or project
modification not covered under this permit, require further written permit DCM Field Representative
approval.All work must cease when this permit expires on: 943 Washington Square Mall
31 December 2025 W s i ((4to , NC 2 89'
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
another party without the written approval of the Division of Coastal / Gl'' Cline
Management. / PERMITTEE
(Signature -, ired if conditions above apply to permit)

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(5) All unconsolidated material resulting from associated grading and landscaping shall be retained on site by effective
sedimentation and erosion control measures. Prior to any land-disturbing activities,a baffler line of filter cloth must
be installed between the land disturbing activity and the adjacent marsh or water areas,until such time as the area
has been properly stabilized with a vegetative cover.
(6) The amount of impervious surface shall not exceed 30%of the lot area within 75'of Normal Water Level;
in this case 2,300ft2 of roofline which..is approximately 6% impervious surface within the 75ft AEC.
(7) All other disturbed areas shall be vegetatively stabilized(planted and mulched)within 14 days of construction
completion.

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ROY COOPER 1i1 -14 4,J Sr
Governor ilkad ,
ELIZABETH S.RISER ,,,t.,,,.. , 7
soaemry �,sog ='
BRAXTON DAVIS NORTH CAROLINA
Director Environmental Quality
June 11, 2022
Jeff Cline and Susan Yan
132 Dogwood Circle
Manteo NC 27954
Dear Ms.Spruill&Ms.Yan:
The Division of Coastal Management hereby acknowledges receipt of an application for
State approval for development of Coastal Shoreline (AEC) 0 Shifting Sans, Plot T071 07 001
adjacent to Albemarle Sound in Columbia Tyrrell County. It was dated for 12 May 2022 but
received complete July 5. 2022 and appears to be adequate for processing. The projected
deadline for making a decision is 30 July 2022. Ashley Grandy, Field Representative for the
Division of Coastal Management is responsible for processing your permit and he can be reached
at 252-948-3854. or via email at [e-mail] if you have any questions.
N.C.G.S. 113A-119(b) requires that notice of an application be posted at the location of
the proposed development. Enclosed you will find a "Notice of Permit Filing" postcard which
must be posted at the property of your proposed development. You should post this notice at a
conspicuous point along the property where it can be observed from a public road. Some
examples would be: nailing the notice card to a telephone pole or tree along the road right-of-
way fronting the property, or at a point along the road right-of-way where a private road would
lead one into the property. Failure to post this notice could result in an incomplete application.
You may be contacted for an onsite inspection if additional information is required by
other appropriate State or Federal agencies. Please contact me if you have any questions and
notify me in writing if you wish to receive a copy of my field report and/or comments from
reviewing agencies.
Sincerely, "sic
Ashley randy Representative
Division of Coastal Management
Washington Regional Office
ENCLOSURE
Cc: WARO DCM
Robert Tankard,WaRO, DWR
Tyrrell County Inspections
D �- North Carolina Department of Environmental Quality I Division of Coastal Management
`v�Jt/t Washington Office 1943 Washington Square Mall I Washington,North Carolina 27889
NORTH CAPOL1Wk
" �r� /`e 251946.6481

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LAMA PERMIT
APPLIED FOR
PROJECT: eonck III+ion rl a new 4g ' XIV single Thmill reticle:net , I cea WW
apprhxirna+PI SS' landward tilt exis4ina d,rair►oney °anal as well
as -I4 s inS-Ial�A�ion of- a septic PPe.ld and -Ww accthia ierl grardirt9 4
f ;5oo4�� w t4in5 -File 15-1 CAMA AEC . The a-r posed im ptcv i ouc sur$arec
Wi in -File /5' ('AMA ACC is ± a,300c+t n Atilt allowable ± Ia,aooc+?
COMMENTS ACCEPTER THROUGH See Below
APPLICANT: FOR MORE DETAILS CONTACT
THE LOCAL PERMIT OFFICER BELOW:
h Shlc4in5 Sands Prshlry Gra.ndm add Rep
Plot TO/ 1 - 01- 001 Division oP Caas4ai Masav/+Aeivl-
Co!um bra /Ve. a79 a 5 a43 W&th;ne+o* Sig WI
Waaki454& Ne aien
(a5461'41 3854

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APPLICATION FOR
CAMA MINOR
CoastalManagementDEVELOPMENT
fNYiRCi+YEt.':AL.OUAL'ir PE RIVIIT
In 1974,the North Carolina Conceal Assembly passed the Coastal Area Management Act
tC AMA)and set the stage for guiding development in fragile and productive areas that
border the slate's sounds and oceanfront.Along with icquiring special care by those who
build and deseiop.the Central Assembly directed the(oaslal Resources Commission
((R(;)to implement dear regulations that isiinimi,c the burden on the applicant.
3
i This application fora minor deselopment permit under C:AxlA is part of the
(ommission's effort to meet the spirit and intent of the Gene al Assembly.It has been
designed to be straightforward and require no more time or effort than necessary from
the applicant.Please go user this folder w lth the local Permit Officer 4LPO)fur the —
locality in which you plan to build to he certain that you understand wbat information he _—
3 or she nerds before you apply. j
Under CA MA regulations,the minor permit Is to be issued ssithin 25 days once a ;-,
complete application is in band.Often less lime Is needed if the project is simple.1 he n
process generally takes uhout IS days.lbw can speed the approval process by making ,
certain that yuut application is complete and signed.that your drawing tuects the
specifications gisen Inside and that your application fee is attached. :
IOther permits are sometimes required for des clopment in the coastal area.11 hale these '
1 are not( AMA-related.we urge you to check ssith the Local Permit Officer to determine
sr which of these you may need.A list is included on page two of this folder.
Ike appreciate your cooperation with the North Catolina Coastal Management Program
and sour willingness to build in a way that protects the resources of our beautiful and
product is e coast.
Coastal Resources Commission
i Division of Coastal Management
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()evil Hazard _ Lstua;ine She}reline a Nuhkic Ttuvt Shoreline Other
I.ur Oficral use out,'
(;ENE;RAI.I'-ORM ION
LAND OM\F_R-MAILING ADDRESS
Name —.. —
Address 1
Ctty t,l State Lip '"' Phone
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LOCATiO1 OF PROJECT:(Address,stieet name:utter<t:recuotu to WC;:MU:of the adjacent»aterN tt
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' +a Si.tKrt. •'.•'1 le o -'1 i`r�l to AI14:r-71,1.1..`S6::ritl
DES( RIPTION OF PROJECT:(List ail proposed construction and Land disturbance
r.i:_' `=r.t , r,,:pt)..:ful, • LonU-'tn-& O &f(iL SySktfr1 tUi ik rf')51.)$ fi eft 1 is f
SIZE OF LOT/PARCEL: __ .yi,arc Ii CI --- a<rCs
PROPOSED USE.:Resid nttal [] iSingirfaluily Q Multi-faintly Q i Commercial lrulusir.al0 Other f I
C OM PLEt E Ell HER(I)OR(2)BELOW(Contact your Local Permit Officer if you are net sure which.IEC applies
to i'aUr property):
):
(1) OCEAN HAZARD AECs:TOTAL FLOOR AREA OF PROPOSED STRUCTURE: square feet(includes
an-conditioned hying space.parking:IesateJ also%e ground iei,cl,non-conditioned space des rood also\c ground Ic‘el bu•
exctudtne non load-bearing attic space)
(2) COASTAL.SHORELINE AE.Cs: SIZE OF HLiil.UlN“roc 1TPRIN I AND OTILF.R IMPERVIOUS OR BRILL
t IS yAOO square feet(include du:arc.!oldie foundation of all buildings.drtsewaya,cut ered deck._
1.ittrCte or Illtminf paths eh:.that art It.al:.n the applicable Ai(' .Au.0 h sour calculations with the prurcti drawing I
SI ATE STOR.NIMATER'MANAGEMENT PERMIT: Is tire pta,._,t It.cated in an am cubicct to a Sutc
Stomlwatei Managc'tiiit Permit)sired M ti:r Nt l)it isn.n of I were;'.,. Mineral and Land Resources(DEMLR1:'
YES Ni)
It yes,list llid io!at h31It opt+n areCitllpersi Otis\urt,n c tin -soui lot or pace'. square leer.

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01 III K 111.1411111N N1A1 8F. HI-t)1 lit}II The as'Iv:i s„u.tr?001'11 nt.era} regime penmts +':+er than the( ,%Af 1
)atilt t Jec c lo;nrcrn permit.lob_ink:luding,taut nut Witted to.[)rtni.rng WaterWater\\'ell. Septic [ank tot o!I►cr..,;soar waste
regime
treatment!es stem).Building.Electrical.Numbing.fleabag and Air t onditiurtfg.Iniulatxm anti I nog C rinser.anon. I IA
Certification.Sand thine.Sediment Comm',Sundiv isi t'Appruc;t:.Nit-Aide)bete Park Approval.I lit.lot as Connection_ :rid
angers. C'ltci.k is ith yoir i real Permit Officer for note information
SIA•I F.NIEN I OFO1\SI.RS1(IP:
I.the undersigned,an applicant for a("AMA minor descloprttent perms,bring either the owner of pmi'terty to an AEC itt-1
p rsuti asnhunc.cJ to act 3s an n1 ent Cut purposes of,ipptying for a C.AMA mirror dec cktpntetil p;rttut.cen In ilx that c pi rstsn
I listen as landowner on this appheanon has a significant interest in the real p:operty described therein llus interest can p"-
I dexs.nhed as (check tine)
k 311 owner or retard title.Title is lusted in name t __._'.,4(- e7, A Cl'''''an+a..'.-'dc. Ya., ___ _
o.'Deed Book ,:,.•__...__. page ._ i` in the Lirtti .� County Registry of Deeds
i .._ an owner by virtue of inhentancr Apttiieant is an heir to the eataic of
probate 1v414 in__.. Crur.'s.
if tither rnletest. such.....s written contract or lease.explain below or use a+epatate sheet&attar 11 to tint`ap; lr.tticn
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I NO1 IIr1CACIOf1 OF ADJACENT RIPARIAN PROPERTY ON'NFRS:
1 I l'unhertno:c certify that the following persons ate owners of properties adjoining this property I affirm that I have gisen
AC-11 4l.SOTI('E to each of them concerning rn intent to deselup this ptoperty and to apply for a('AMA pensirt
t Name) (Address)
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AC KNOWLE:OGEME\TS:
I.the tlndcrsifmed.acknowledge that the land owner is aware that the proposed development is planned for an iirt•.t sslnc'1
may be suscepnbie to erosion and?ot fkxxtmj.I acknow ledge that the Local I'euna Officer lus c.a.pharlcd h+me the ftariit u
tar hazard problems associated with this lot 1 his explanation was accompanied by recommendations concernme staht.ifa-
uon anti floodrroofinc techniques
I furthermore scrtif) Mai I ant authurteed to faa"t.aiid do in lair grant.pe.nlissur,to I)►vistan of Coastal Management staff.
the Local Permit Otlicur and their agents to enter on the afo:cntcntiorcd lands in connection with evaluating infrrrnianon
It:IM d h)this permit aptplication.
Th1s the ..t day of May 20 .
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i a de tic or ptne;n auth"taied it,at:,as hts•her agent fur purp osc rf tiling a t'A!i\perity!application
llur application nu-hides;ger'ew!;I1!.ttmaws:(this futlpi a stir dt:ft:ure,r. it.,.rtl+r'tf on the harp of this upftluariten, ti:<
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N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property Owner:Jeffrey A Cline and Susan Yan
Address of Property: Shifting Sands Road
Mailing Address of Owner: 132 Dogwood Cir. Manteo, NC 27954
Owner's email: leffcline.ectngmail.com Owner's Phone#: [phone]
Agent's Name: Agent Phone#:
Agent's Email:
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adlacent Property Owner)
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 DO NOT have objections to this proposal. I DO have objections to this proposal.
If you have objections to what is being proposed, you must notify the N.C. Division of Coastal
Management(DCM) in writing within 10 days of receipt of this notice. Correspondence should be
mailed to 943 Washington Square Mall, Washington, NC 27889. DCM representatives can also be
contacted at(252)946-6481_No response is considered the same as no objection if you have been
notified by Certified Mail.
WAIVER SECTION
I understand that any proposed pier,dock,mooring pilings,boat ramp, breakwater,boathouse, lift, or
groin must be set back a minimum distance of 15'from my area of riparian access unless waived by me
(this does not apply to bulkheads or riprap revetments). (If you wish to waive the setback, you must sign
the appropriate blank below.)
I DO wish to waive some/all of the 15'setback
Signature of Adjacent Riparian Property Owner
-OR-
I do not wish to waive the 15'setback requirement(initial the blank) IC
Signature of Adjacent Riparian Floor Owner i z.fEeLQ 14
d
Ty fPrintename`oTARPO: �, ! +e,5 PlAw ers
\\ ter-
Mailing Address of ARPO: Ufli CnlLw,y:c; tl rn' 02S
ARPO's email: v tA\' A AR$� wQ`v`�''�Nr`(! .o., PO s Phone#: at-„thc‘-rprci g
Date: 7Abbr 2.t... 'waiver Is valid for up to one year from ARPO's Signature'
6 j S Revised July 2o21

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Country Estates Property Owners Association
P.O. Box 411
Columbia, NC 27925
5/18/2022
NC Division of Coastal Management:
We received the attached "Adjacent Riparian Property Owner Notification Form"from Jeff Cline and
Susan Van. There was no description or drawing of the proposed development included,and therefore,
no way for us to evaluate the proposal.
Thanks.
Howard Phillips, President
CEPOA
[e-mail]
252/796-7842
RECEIVED
MAY 2 0 2022
DCM-WARO

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property Owner: Jeff Cline and Susan Yan
Address of Property: #Shifting Sands Road Columbia NC (T071 07 001)
Mailing Address of Owner: 132 Dogwood Cir. Manteo NC 27954
Owner's email:obxquns(o gmail.com Owner's Phone#:p52-423-1265
Agent's Name: N/A Agent Phone#: N/A
AgentsEmail: N/A -
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adiacent Property Owner)
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 DO NOT have objections to this proposal. I DO have objections to this proposal.
if you have objections to what is being proposed, you must notify the N.C. Division of Coastal
Management(DCM)in writing within 10 days of receipt of this notice. Correspondence should be
mailed to 943 Washington Square Mall, Washington, NC 27889. DCM representatives can also be
contacted at(252) 946-6481. No response is considered the same as no objection if you have been
notified by Certified Mail.
WAIVER SECTION
I understand that any proposed pier, dock, mooring pilings, boat ramp, breakwater, boathouse,lift,or
groin must be set back a minimum distance of 15'from my area of riparian access unless waived by me
(this does not apply to bulkheads or riprap revetments). (If you wish to waive the setback,you must scan
the appropriate blank below.)
I DO wish to waive some/all of the 15'setback
Signature of Adjacent Riparian Property Owner
-OR-
I do not wish to waive the 15'setback requirement(initial the blank)
Signature of Adjacent Riparian Property Owner:
Typed/Printed name of ARPO:
Mailing Address of ARPO:
ARPO's email: ARPO's Phone#:
Date: ''waiver Is valid for up to one year from ARPO's Signature*
Revised July 2021

TIPS FOR ADJACENT RIPARIAN OWNER NOTIFICATION &WAIVER FORMS
CAMA Regulations require notice of proposed development to the Adjacent Riparian Property Owners(15A
NCAC 7J.0204(b)(5)). Proof of actual notice (a sign-off by the owner on this form) or certified mail return
receipts (showing delivery of notice)are needed.
The purpose of this notice is to make adjacent riparian property owners aware of the proposed development
so that they have an opportunity to provide comments (or potentially object to)the proposed development,
and to give DCM an opportunity to consider these comments/objections before a permit decision is made.
"Permission"of adjacent property owners is not necessarily required for DCM to issue a permit; however,
permission must be obtained for certain types of proposed developments if they fall within a 15'setback area
along the riparian access area of the adjacent property,as determined solely by DCM. It is in the applicant's
best interest to provide comprehensive and accurate notice so that any concerns or objections can be
resolved early in the permit review process. In addition, if the adjacent riparian property owner appeals the
permit decision, insufficient notice could be a basis for granting such an appeal.
- Who is an Adjacent Riparian Property Owner? - - -- - - - -
What is Adjacent?(Note: DCM reads this broadly to ensure comment by potentially impacted neighbors)
• A property that shares a boundary line with the site of proposed development;AND
• A property that fronts a natural or manmade waterbody that is connected to coastal waters and
can support some form of navigation, even a kayak or canoe, including a common canal system
or a manmade basin.
• Easement holders?Yes, if the easement could be impacted by the proposed development.
• Streets/Roads?Only if the street/road could be impacted by the proposed development.This
might include street-ends which might be used for parking and beach access.
• Holders of recognized submerged lands claims/shellfish franchises.
What is Riparian?
Do the boundaries of the adjacent property legally intersect with the water at mean high tide? If there is a
question about whether an adjacent property is considered "riparian," please reach out to DCM Staff-
especially on the oceanfront beach where there may be undeveloped parcels on the beach or in the water.
Who/What is a Property Owner?
For private individuals(or families),send notice to the address listed on the tax card.If the property is owned
by an Inc. or LLC, please send notice to the person listed as the registered agent on the NC Secretary of
State's Corporations Look Up site: https://www.sosnc.00v/search/index/corp. For Condominiums or
neighborhoods with an owners'association (HOA/POA),send notice to the association(which is usually a
corporation,for which you send notice to its registered agent).
What is Notice,and how do I ensure it Is received?
• You can meet with your adjacent property owner, provide a description or drawing of the
proposed development, and ask them to sign this form and return it to DCM; OR
• You can hand-deliver this form and a description or drawing, and ask your neighbor to return it to
DCM (consider providing them with a stamped envelope); OR
• You can mail this form by USPS Certified Mail, return receipt requested(the Green Card). If you
choose this option,you must provide either the signed&returned green card OR track-the
certified mail package number on USPS.GOV's online tracking system, and provide the tracking
print-out as proof of delivery to DCM
If you have any questions about this process, please reach out to DCM Staff and DCM Legal Counsel
and we will work to answer your questions.
Revised July 2021

RECEIVED
MAY 17 Z02Z b
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APPLICATION I�6M-WARD?
CAMA MINOR
Coastal Management DEVELOPMENT
ENVIRONMENTAL DUALITY
PERMIT
In 1974, the North Carolina General Assembly passed the Coastal Area Management Act
(CAMA) and set the stage for guiding development in fragile and productive areas that
border the state's sounds and oceanfront.Along with requiring special care by those who
build and develop,the General Assembly directed the Coastal Resources Commission
(CRC)to implement clear regulations that minimize the burden on the applicant.
This application for a minor development permit under CAMA is part of the
Commission's effort to meet the spirit and intent of the General Assembly. It has been
designed to be straightforward and require no more time or effort than necessary from
the applicant.Please go over this folder with the Local Permit Officer(LPO)for the
locality in which you plan to build to be certain that you understand what information he Or
or she needs before you apply.
Under CAMA regulations,the minor permit is to be issued within 25 days once a "3
complete application is in hand. Often less time is needed if the project is simple. The
process generally takes about 18 days.You can speed the approval process by making
certain that your application is complete and signed,that your drawing meets the
specifications given inside and that your application fee is attached.
Other permits are sometimes required for development in the coastal area.While these
are not CAMA-related,we urge you to check with the Local Permit Officer to determine
which of these you may need.A list is included on page two of this folder.
We appreciate your cooperation with the North Carolina Coastal Management Program
and your willingness to build in a way that protects the resources of our beautiful and
productive coast.
Coastal Resources Commission
Division of Coastal Management
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DCM Form E81952-2015/Revised

Locality Permit Number
Ocean Hazard Estuarine Shoreline ORW Shoreline Public Trust Shoreline Other
(For official use only)
GENERAL INFORMATION
LAND OWNER-MAILING ADDRESS
Name Jeff Cline and Susan Yan
Address 132 Dogwood Circle
City Manteo State NC Zip 27954 Phone [phone]
Email obxquns©gmail.com
AUTHORIZEDAGENT - - - --
Name
Address
City StaN Zip Phone
Email
LOCATION OF PROJECT: (Address, street name and/or directions to site;name of the adjacent waterbody.)
Shifting Sands, Columbia NC Plot: T071 07 001
Last lot at the end of subdivision, located next to Albermarle Sound.
DESCRIPTION OF PROJECT: (List all proposed construction and land disturbance.)
Construction of a single family dwelling. Minimal land impact as home will be built on stilts.
SIZE OF LOT/PARCEL: square feet 7 acres
PROPOSED USE:Residential 0 (Single-family® Multi-family 0 ) Contmercialllndustrial 0 Other 0
COMPLETE EITHER(1)OR(2)BELOW(Contact your Local Permit Officer ifyon are not sure which AEC applies
to your property):
(1) 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 FOOTPRINT AND OTHER IMPERVIOUS OR BUILT
UPON SURFACES: 3200 square feet(includes the area of the foundation of all buildings,driveways,covered decks,
concrete or masonry patios,etc. that are within the applicable AEC.Attach your calculations with the project drawing.)
STATE STORM WATER MANAGEMENT PERMIT:Is the project located in an area subject to a State
Stomtwater Management Permit issued by the NC Division of Energy,Mineral and Land Resources(DEMLR)?
YES NO X
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 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,Heating 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 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 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)
X an owner or record title,Title is vested in name of Jefrey A Cline and Susan Yan
see Deed Book 255 page 860 in the Tyrrell County Registry of Deeds,
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.
NOTIFICATION OF ADJACENT RIPARIAN PROPERTY OWNERS:
1 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 permit.
(Name) (Address)
(1) Country Estates PO Box 411 Columbia, NC 27925
(2) James Scott Calhoun Jr. PO Box 1823 Beckley, WV 25802
(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.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-
tion and fioodproofing techniques.
1 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.
This the 12th day of May ,20 22
0,0 s4.
La I• • i e.or person authorized to act as his/her agent 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, the
ownership statement, the Ocean Hazard AEC Notice where necessary, a check for S100.00 made payable to the locality, and
any information as men be provided orally by the applicant. The details of the application as described by these sources are
incorporated without reference in any permit which may be issued. Deviation from these details will constitute a violation of
-any permit.Any person developing in an AEC without permit is subject to civil, criminal and administrative action.