OIB_04-99_Hendrix/Miller

Locality C(L=`z��
GENERAL INFORMATION
LAND OWNER
NameWAIwc_�
Address L
AUTHORIZED AGENT
Name
Address
City
DIVISION OF
TAL MANAGEM
Ok$
Qtk-9
LOCATION OF -• • 9 HALLb7rr=L.._ c• P • L_
GLcc K inr•• .. : L np -
(If not oceanfront, is waterbody natural or manmade?)
DESCRIPTION OF PROJECT SINGLE— FAmILy RESlDE7Jc€ ANI7
AREAS OF ENVIRONMENTAL CONCERN (AEC) CLASSIFICATION
(To be filled in by the Local Permit Officer prior to completing application.)
X_ Ocean Hazard Estuarine Shoreline ORW Shoreline Other
PROPOSED USE
X Residential Commercial/Industrial Other
SQUARE FOOTAGE OF BUILDING FOOTPRINT AND OTHER IMPERVIOUS OR
BUILT -UPON SURFACES (such as driveways, etc.) within 75 feet of the shoreline (575 feet
of an ORW shoreline) A//,4
SQUARE FOOTAGE OF TOTAL FLOOR AREA OF BUILDING a?, 0 40 SF
SQUARE FOOTAGE OF SITE (o l 3/ SF
OTHER PERMITS MAY BE REQUIRED:
The activity you are planning may require
permits other than the CAMA minor
development permit. As a service we have
compiled a listing of the kinds of permits that
might be required. We suggest you check
over the list with your LPO to determine if
Zoning, Drinking Water Well, Septic Tank
(or other sanitary waste treatment system),
Burning, 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.
any of these apply to your project.

STATEMENT OF OWNERSHIP SEP 14 2004 REcEHvED
I, the undersigned, an applicant for a CAMA minor development4"M*F g7roperty in
an AEC or a person authorized to act as an agent for purposes of e opment
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 WApE )4 , dgNNa /L Epee Deed Book /990
pageoo q9 in the &! u_ wJ/c1�County Registry ot Deeds. '
_ an owner by virtue of inheritance. Applicant is an heir to the estate of
probate was in County.
if other interest, such as written contact or lease, explaiiattach to this
application. ''IIr) Ie n
"rj
NOTIFICATION OF ADJACENT PROPERTY OWNERS
I furthermore certify that the following persons are owners of properties adjoining this property. I affirm that I
have given ACTUAL NOTICE to each of them concerning my intent to develop this property and to apply for .
a CAMA permit.
(Name)
(Address)
+E. ► o 8..
FOR DEVELOPERS IN OCEAN HAZARD AND ESTUARINE HAZARD AREAS:
I 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
particular hazard problems associated with this lot. This explanation was accompanied by recommendations
concerning stabilization and floodproofing techniques.
PERMISSION TO ENTER ON LAND
I furthermore certify that I am authorized to grant and do in fact grant permission to the local permit officer
and his agents to enter on the aforementioned lands in connection with evaluating information related to this
permit application.
This application includes: general information (this form), a site drawing as described on the back of this ap-
plication, the ownership statement, the AEC hazard notice where necessary, a check for $50.00made payable to
the locality, and any information as may 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 a per-
mit is subject to civil, criminal and administrative action.
This the e�2__ day of SEPT'Em60Z, 20 6 4 .
Land owner or -person author ze o act as his agent
for purposes of filing a CAMA pem-dt application.

SEP 1 4 2004 h
DIVISION OF =
COASTAL MANAGIMENT
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LOT 13
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LOT 15
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MIN 5' (TYP)
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82'26'00'E ,123,04'
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NW
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56'
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NW '
7'
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PROPOSED
36 p 0
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25 S GLE-FAY
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12' RESIDENCE
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f1R LOT 2
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2'
42'
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T 6,06•W 129,72'
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72'
�OOFFIRSTIELE
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APPRNA�O�FEYOC R�
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BASE MAP PROVIDED BY
TOMPKINS LAND SURVEYING

Project Is In An: V 0cean Erodible Area High Hazard Flood Area Inlet Hazard Area
This notice is intended to make you, the applicant, aware
of the special risks and conditions associated with
development in this area, which is subject to natural
hazards such as storms, erosion and currents. The rules of
the Coastal Resources Commission require that you
receive an AEC Hazard ]Notice and acknowledge that
notice in writing before a permit for development can be
issued.
The rasa. ssion'srulesonlwilding�tandards oceanront
...: &L .__:... cur,--!
npt d_minahp -ern+,>rry Inc. —_T11 '_rrlc_ BV �•rgx�_ina
nor
ar >_u l�-J no
liability for future damage to the development.
The best available information, as accepted by the Coastal
Resources Commission, indicates that the annual ocean
4er on rate for the area where your property is located is
s feet per year.
The rate was established by careful analysis of aerial
photographs of the coastline taken over the past 50 years.
Studies also indicate that the shoreline could move as
much asaAO feet landward in a major storm.
The flood waters in a major s torm are predic ted to be about
feet deep in this area.
Preferred oceanfront protection measures are beach
nourishment and relocation of threatened structures.
Hard erosion control structures such as bulkheads,
seawalls, revetments, groins, jetties and breakwaters are
prohibited. Temporary devices, including sand bags, may
be allowed under certain conditions.
This structure shall be relocated or dismantled within two
years of becoming imminently threatened.
The applicant must acknowledge this information and
requirements by signing thus notice in the below space.
Without the proper signature, the application will not be
complete.
!A
ipplicant's Signature
q-3-
Date
SPECIAL NOTE: This hazard notice is required for
development in areas subject to sudden and massive
storms and erosion. Permits issued for development in this
area expire on December 31 of the third year following the
year in which the permit was issued. Shortly before waork
begins on the project site, the Local Permit Officer will
determine the vegetation line and setback distance at your
siteif the property leas seen little change and the proposed
development can still meet the setback requirement, the
LPO will inform vouIthat you may begin work. I t is impor-
tan t that you check with tRe LPO before the permi±expires
for o-zlicial =._ _ro v al .o commu'e me work aster' _ t _mr-z
has exrsired. Generallv. if foundation vilincs hav- been
not been made, the permit must be renewed and a new
setback line established. It is unlawful to continue work
after permit expiration without this approval.
For more information, contact:
Local Permit Officer
3 Idesr—nn;rC1 4.
Address
O -eAfl M;le- EtG42{l
Locality
�'11n-57q-340
Phone
E(DE:'v"E
SEP 1 4 2004
DIVISION OF
COASTAL MANAGFhAP:NT
Revised 11193