OIB_04-111_Freeeman

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Locality rl Permit
Ocean Hazard _ Estuarine Shoreline ZORW Shoreline _Public Trust Shore
(For official use only)
GENERAL INFORMATION I I I 1 I E C E
LAND OWNER
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SEP 2 7 2004
Address 7S A i—�� )LZ(J MYN ur uttpn ISLE
PLANNING & fNSPEC'
City State r/ G Zip Z A'lnO l Phone
AUTHORIZED AGENT
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004
J OF
AGEMENT
Name
Address r� • jj (p( �G {
City ��i.n l (0 4•� ¢ State Zip Zn 1- Phone` 4 '�s�r. 3
LOCATION OF PROJECT: (Address, stre trname and/or directions to site. If not oceanfront, what is the name of
the adjacentwaterbody?)
DESCRIPTION OF PROJECT: (List all proposed construction and land disturbance.)
SIZE OF LOT/PARCEL: �5 �Y j 75 I square feet acres
PROPOSED USE: Residential (Single-family ✓Multi -family_) Commerical/Industrial _
Other
TOTAL ENCLOSED FLOOR AREA OF A_ BUILDING IN THE OCEAN HAZARD AREA OF ENVI-
RONMENTAL CONCERN (AEC): _ square feet (includes all floors and roof -covered decks)
SIZE OF BUILDING FOOTPRINT A&D OTHER IMPERVIOUS OR BUILT -UPON SURFACES IN
THE COASTAL SHORELINE AREA OF ENVIRONMENTAL CONCERN (AEC): 32 sq, fc_
(Calculations include the area of the roof/drip line of all buildings, driveways, covered decks, concrete or masonry patios,
etc. chat are within the applicable AEC. Attach your calculations with the project drawing.)
Choose the AEC area that applies to your property:
(1) within 75 feet of Normal High Water for the Estuarine Shoreline AEC
(2) within 575 feet of Normal High Water for the Estuarine Shoreline AEC, adjacent to Outstanding
Resource Waters
(3) within 30 feet of the Public Trust Shoreline AEC
(Contact your Local Permit Officer if you are not sure which AEC applies to your property.)
STATE STORMWATER MANAGEMENT PERMIT: Is the project located in an area subject to a
State Stormwater Management Permit issued by the N.C. Division of Water Quality?
YES_ NO
If yes, list the total built -upon arealimpervious surface allowed for your lot or parcel. square feet.

f
ECEIVE
OTHER PERMITS MAY BE REQUIRED: The activity you are planning may require permits odi the &,�n
,204
development permit. As a service we have compiled a list of the kinds of permits that might be required. We suggest you ve the list
with your LPO to determine if any of these apply to your project: Zoning, Drinking Water Well, Septic Tank (c��s �1 Q F
treatment system), Burning, Electrical, Plumbing, Heating and Air Conditioning J� ((��ll p��Q 22 ��EMENT
Sand Dune, Sediment Control, Subdivision Approval, Mobile Home park ApproQp�al{ih:ofie 'odUantCo �!.
STATEMENT OF OWNERSHIP: u 4 SEP 2 7 2004 U
I, the undersigned, an applicant for a CAMA minor development permit, eing either the owner of pro erry ' i an AEC or a
person authorized to act as an agent for purposes of applying for a CAMA minor & I�CTII)fl Iterufy at the person
listed as landowner on this application has a significant interest in the real h rest can be
described as: (check one)
_an owner or record title. Tide is vested in �x L �_r E Q ,��_ see Deed Book
page in the County Registry of Deeds.
_an owner by virtue of inheritance. Applicant is an heir to the estate of
xrobate was in County.
_if other interest, such as written contract or lease, explain below or use a separate sheet and attach to this application.
JOTIFICATION OF ADJACENT PROPERTY OWNERS:
furthermore certify tEat the following persons are owners of properties adjoining this property. I affirm that I have given
CTUAL NOTICE to each of them concerning my intent to develop this property and to apply for a CAMA permit.
(Name)
l) T%% 1.1 i l (Address)
f)
F)
011 DEVELOPERS IN OCEAN HAZARD AND ESTUARINE HAZARD AREAS:
N c.
cknowledge that the land owner is aware that the proposed development is planned for an area which may be susceptible to
�sion and/or flooding. I acknowledge that the local permit officer has explained to me the particular hazard problems associ-
d with this lot. This explanation was accompanied by recommendations concerning stabilization and floodproofing tech-
lues.
?RMISSION TO ENTER ON LAND:
irthermore certify that I am authorized to grant and do in fact grant permission to the local permit officer and his agents to
on the aforementioned lands in connection with evaluating information related to this permit application.
s application includes: general information (this form), a site drawing as described on the back of this application, the
tership statement, the AEC hazard notice where necessary, a check for $100.00 made payable to the locality, and any infor-
ion as may be provided orally by the applicant. The details of the application as described by these sources are incorporated
rout reference in any permit which may be issued. Deviation from these details will constitute a violation of any permit. Any
on developing in an AEC without permit is subject to civil, criminal and administrative action.
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Postal
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CERTIFIED
MAIL,,,
RECEIPT
(Domestic
Mail
Only;
No Insurance
Coverage
Provided)
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Postage $
ocemged Fee $2.30 0470
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O Retum Rsclept Fee 09 Postmark
(Endorsement Required) 50•� Here
O Restricted Delive Fee
(Endorsemert Required) 40, 00
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$ 09/24/2004
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SEP 2 9 2004
DIVISION OF
COASTAL MANAGEMENT