18-13 Anderson

NC Division of Coastal 18-13
Mana_ e� Permit Number
a
i i t DEVELOPMENT
PERMII�
as authorized by the Mate of north Carolina, Department of Environment,
and natural Resources and the Coastal Resources Commission for development
in an area of environment concern pursuant to section 113A-138 of the
General Statutes, "Coastal Area Management"
Issued to Gary and Kathryn Anderson c/o Anthony French, authorizing development in the Estuarine Shoreline (AEC) at the
property located at 241 Shell Landing Road, in Beaufort, as requested in the permittee's application, dated 12/4113. This permit,
issued on 12/20/13, 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: grading, clearing, filling and landscaping of the lot, construction of a shed and a portion of the single family
residence within the AEC.
(1) All proposed development and associated construction must be done in accordance with the permitted work plat
drawings(s) dated received on 12/12/13.
(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 252-808-2808 for a final inspection at
completion of work. The issuance of a Certificate of Occupancy is dependent upon satisfactory completion of a final
inspection.
(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. 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
project is inspected for compliance. Any maintenance work or project
modification not covered under this permit, require further written permit
approval. All work must cease when this permit expires on:
12/31 /2016
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
Management.
Heather M. Styron
NC Division of Coastal Management
400 Commerce Ave.
Morehead Ci)y, NC.2855- —,G .A:
l
PERMITTEE
(Signature required if conditions above apply to permit)

Name: Gary and Kathryn Anderson
Minor Permit # 18=13
Date: 12120/13
Page a
(5) All unconsolidated material resulting from associated grading and landscaping shall be retained on site by effective
sedimentation and erosion control measures. Sedimentation and erosion control measures shall be properly
maintained throughout the construction period.
(6) This permit does not authorize development within any wetlands or open water areas,
(7) In order to protect all adjacent public and private properties from damage by land disturbing activities and runoff, a
permanent functional and adequate erosion and sedimentation control measure must be installed to prevent
sediment runoff from entering estuarine waters and other properties.
SIGNATURE:
PERMITTEE DATE:

SITE DRAWING/APPLICATION CHECKLIST
Please make sure your site drawing includes the following information required for a CAMA minor development permit.
The Local Permit Officer will help you, if requested.
PHYSICAL DIMENSIONS
Label roads
Label highways right-of-ways
Label local setback lines
Label any and all structures and driveways currently existing on property
Label adjacent waterbody
PHYSICAL CHARACTERISTICS
Draw and label normal high water line (contact LPO for assistance)
Draw location of on -site wastewater system
If you will be working in the ocean hazard area:
Draw and label dune ridges (include spot elevations)
Draw and label toe of dunes
Identify and locate first line of stable vegetation (contact LPO for assistance)
Draw and label erosion setback line (contact LPO for assistance)
Draw and label topographical features (optional)
If you will be working in a coastal shoreline area:
Show the roof overhang as a dotted line around the structure
Draw and label landward limit of AEC
Draw and label all wetland lines (contact LPO for assistance)
Draw and label the 30-foot buffer line
DEVELOPMENT PLANS
Draw and label all proposed structures
Draw and label areas that will be disturbed and/or landscaped
Note size of piling and depth to be placed in ground
Draw and label all areas to be paved or graveled
Show all areas to be disturbed
Show landscaping
NOTE TO APPLICANT
Have you:
• completed all blanks and/or indicated if not applicable?
• notified and listed adjacent property owners?
• included your site drawing?
• signed and dated the application?
• enclosed the $100.00 fee?
• completed an AEC Hazard Notice, if necessary? (Must be signed by the property owner)
FOR STAFF USE
Site Notice Posted Final Inspection Fee Received
Site Inspections
Date of Action: Issued Exempted Denied Appeal Deadline (20 days from permit action)
APPLICATION FOR
„�C 12 2°'CAMA MINOR
Qi1
NELOPMENT
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 she needs before you apply.
Under CAMA regulations, the minor permit is to be issued within 25 days once a
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.
DCM Form EB1952-2010/Revised April 2010
Coastal Resources Commission
Division of Coastal Management
1i
b
M
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Locality
Permit Number 1 t/
Ocean Hazard Estuarine Shoreline r ORW Shoreline Public Trust Shoreline Other
GENERAL INFORMATION
LAND OWNER
Name -y- � , C --
RAMIM
(For official use only)
Address
City �Ibl t - -6ZT' State Zip Phone uqS 2-Z,-XJ " U 7-(r ;
Email (mot -� iJ�� G� lyrc C'c�dvt
AUTHORIZED AGENT
Name
Address SCSI
City 1'i.if- uo-- C,4zState zip c Phone
Email (1
cc)
LOCATION OF PROJECT: (Address, street name and/or directions to site. If not oceanfront, what is the name of the
adjacent waterbody.) ' "jjt >i `� t~ /; � 4, pc ✓��L;
DESCRIPTION OF PROJECT: (List all proposed construction and land disturbance.) ' E, if tl W-r, 4k)cl
oo o::�rp.&�o to
SIZE OF LOT/PARCEL: square feet ..= acres
PROPOSED USE: Residential (Single-family E] "Multi -family E] ) Commercial/Industrial ❑ Other
COMPLETE EITHER (1) OR (2) BELOW (Contact your Local Permit Officer if you 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: square feet (includes the area of the roof/drip line 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 STORMWATER MANAGEMENT PERMIT: Is the project located in an area subject to a State Stormwater
Management Permit issued by the NC Division of Water Quality?
YES NO t-C -T (? �_� � : ` .
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)
an owner or record title, Title is vested in�`�l ,���>►J , see Deed Book �'�✓ i-i'
page c (' in the °,. : County Registry of 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 contract or lease, explain below or use a separate sheet & attach to this application.
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.
t (Name) (Address)
(1) y. iY '�u`�` � oc; cad 8S j
(2) z`"'I S� LAr�-�5 &P ,IebL : ;q 4S C, aBSJ ,
(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 floodproofing techniques.
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.
,,\
This the 1` day of�L). ?L.., , 20 # -')
Landowner or persoh 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 $100.00 made 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 permit is subject to civil, criminal and administrative action.

NCDENR
North Carolina Department of Environment.and Natural Resources
Division of Coastal Management
Pat McCrory Braxton C. Davis John E. Skvarla, III
Governor Director Secretary
December 17, 2013
Gary and Kathryn Anderson
C/o Anthony D. French
501 Twin Lakes trail
Newbern, NC 28560
Dear Mr. /Mrs. Anderson:
The NC Division of Coastal Management hereby acknowledges receipt of your application for State approval
for minor development at the property located at 241 Shell Landing Road located in Beaufort on a manmade
canal that connects to North River. The application was accepted as complete on 12/12/13 and the projected
deadline for making a decision is 1/6/13.
NCGS 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 your 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 your property; or at a point along the road right-of-way where a private
road would lead one into your property. Failure to post this notice could result in an incomplete application.
An onsite inspection will be made, and if additional information is required, you will be notified. Please contact
me at 252-808-2808 ext. 216 if you have any questions.
Sincerely,
Heather M. Styron
Coastal Management Representative
400 Commerce Ave,, Morehead City, NC 28557
Phone: [phone] FAX: [phone] Internet: www.nccoastalmanagement.net
An Equal Opportun'sty's Affirmative Ac5on Employer

OlAi
1 �A42;1 Igo,
MCA
lovAp An
COMMENTS ACCEPTED THROUGH ta ol-op-o"o
APPLICANT:
FOR MORE DETAILS CONTACT
THE LOCAL PERMIT Q�UICER BELOW:

V
NCDENR
North Carolina Department of Environment and Natura
Division of Coastal Management
Pat McCrory Braxton C. Davis
Governor Director
Date
I
Applicant Dame Mf—P S-0 k)
Mailing Address a ©D e)
Resources
John E. Skvarla, III
Secretary
I certify that I have authorized (agent) i-� t �G�?C�f �44 - to act on my behalf, for the
purpose of applying for and obtaining all CAMA Permits necessary to install or construct (activity)
This
Signa
I -� ke.ct--, I—AK�tjt 10"' E::9 , , at (location)
(date) \ � j , [ i '-�o (4
400 Commerce Ave,, Morehead City, NC 28557
Phone: [phone] FAX: [phone] Internet: www,nocoastalmanagement.net
An Equal Opportunity 1 Affirmative Action Employer
NorthCarolina
Ndift(rallY

Dec 16 13 12:58p p 1
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item 4 it Restricted Delivery is desired.
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is Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee)
7012 101D 0001 3242 8381
5 Form Jb11, February 2004 Domestic Return Receipt
■ Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
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PS Form 3811, February 2004 Domestic Return Receipt 1102595-02 M-15%0

SIC Division of Coastal
Dana eon menf
1 8-13
Permit Number
CAMA
WHOR DEVELOPMENT
PERN
as authorized by the State of Forth Carolina, Department of Environment,
and Natural Resources 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 Gary and Kathryn Anderson c/o Anthony French, authorizing development in the Estuarine Shoreline (AEC) at the
property located at 241 Shell Landing Road, in Beaufort, as requested in the permiffee's application, dated 12/4/13. This permit,
issued on 12/20/13, 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: grading, clearing, filling and landscaping of the lot, construction of a shed and a portion of the single family
residence within the AEC.
(1) All proposed development and associated construction must be done in accordance with the permitted work plat
drawings(s) dated received on 12/12/13.
(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 252-808-2808 for a final inspection at
completion of work. The issuance of a Certificate of Occupancy is dependent upon satisfactory completion of a final
inspection.
(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. 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
project is inspected for compliance. Any maintenance work or project
modification not covered under this permit, require further written permit
approval. All work must cease when this permit expires on:
12/31 /2016
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
Management,
Heather M, Styron
NC Division of Coastal Management
400 Commerce Ave.
Morehead Cif, NC 2.$557'
PERMITTEE
(Signature required if conditions above apply to permit)

Name: Gary and Kathryn Anderson
Minor Permit # 18.13
Date:12120/13
Page 2
(5) All unconsolidated material resulting from associated grading and landscaping shall be retained on site by effective
sedimentation and erosion control measures. Sedimentation and erosion control measures shall be properly
maintained throughout the construction period.
(6) This permit does not authorize development within any wetlands or open water areas.
(7) In order to protect all adjacent public and private properties from damage by land disturbing activities and runoff, a
permanent functional and adequate erosion and sedimentation control measure must be installed to prevent
sediment runoff from entering estuarine waters and other properties.
SIGNATURE: PERMITTEE DATE:

BRIDGETON MPO
BRIDGETO' North Caro
arolina
12,112/2013 3613950621 -0099
[phone] 02:33:01 PM
MWWR
Product Sales Receipt
Description Sale Unit �—
Qty Price Final
(Forever) Price
Purple Heart 4 $0.46
PSA 2012 $1.84
Utility
Mailer 1 $1.19
Utility $1.19
Mailer 1 $1.19
BEAUFORT NC 28516 $1.19
First -Class Mail ne-1
3.60 02. Large Env $1.52
Scheduled Delivery Day. Fri 12/13/13
Return Rcpt (Green Card)
@0 Certified
Label #: $2.55
70121010000132428381 10
Issue PVI; _
BEAUFORT NC 28516 $7.17
First -Class Mai l Large
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3.70 02. a ge Env $1.52
Scheduled Delivery Day: Fri 12/13/13
Return Rcpt (Green Card)
N Certified
Label #: $2.55
70121010000132428374 10
Issue PVI:
Total: $7 17
Paid by: $18.56
Personal Check
®® For tracking$18.56
USPS.com or callI1 rnquiries go t-800-222-18i1.o
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BRIDGETON MPO BRIDGETON, Nort
28519500pCarolina
12/12/2013 3613950621 -0099
[phone]
02:33:01 PM
ProdMONNOW
uct Sales Receipt
Description Sale Unit �—
Oty Price Final
(Forever) Price
Purple Heart 4 $0.46
PSA 2012
$1.84
Utility
Mailer 1 $1.19
Utility
$1.19
Mailer 1 $1.19
BEAUFORT NC 28516
$1.19
First -Class Mail ne-1
3.60 02. Large Env
$1.52
Scheduled Delivery D
Ret
urn ®® Certified (Green Card) Fri 12/13/13
Label #:
$2.55
70121010000132428381'10
Issue PVI; _
BEAUFORT NC 28516
First -Class
$7 17
Mai l La ge E
3.70 o2. Large Env
$1.52
Scheduled Delivery Day: Fri
Return Rcpt (Green Card)
N Certified
12
/13/13
Label #:
$2.55
101210100001324283�4'10
Issue PVI;
Total: $7 17
Paid by: $18-56
Personal Check
60 For tracking
$18.56
LISPS. com or cal ol- 00-22 i es go to
800-222-1811.
Order stamps at usps.com/sho
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Anthony D. French Real Estate & Development, LLC
501 Two Lakes Trail
New Bern, North Carolina 28560
[phone]
[e-mail]
December 6, 2013
Mr. & Mrs. Edward A. Larsen, Jr.
229 Shell Landing
Beaufort, North Carolina 28516
Dear Mr. & Mrs. Larsen,
Enclosed you will find the proper documents required by CAMA for filing for a CAMA
minor permit. Mr. & Mrs. Arnerson are the new owners of 241 Shell Landing, Lot 21.
They wish to construct a new residential dwelling and detached building on the property.
Included with this letter is a plot plan showing the proposed location of the structures to be
built on the lot. Please take the time to review the enclosed documents and return them to the
CAMA office located in Morehead City as soon as possible. Also included is a self- addressed
stamped envelope for your convenience.
Should you have any questions please call Cary Amerson at [phone] or Anthony
French at [phone]. Thank you for your cooperation.
S' cerely,
Antho�Frch

Receipts for
Certified Mail
(Staple Here)
a,
Date
Adjacent Property Owner
`ling Ad ss
City, State, Zip Code
Dear Adjacent Property:
This letter is to inform you that I,'�"�'�' �% have applied for a CAMA Minor
Property Owner P Q
Permit on my property at 'h 4i S k- , 1�4P_-J)n;,� in COUNTY
Property Address
County. As required by CAMA regulations, I have enclosed a copy of my permit application and project
drawing(s) as notification of my proposed project. No action is required from you or you may sign and return
the enclosed no objection form. If you have any questions or comments about my proposed project, please
contact me at 2 I Q (,.,7 or by mail at the address listed below. If you wish to
Applicant's Telephone
file written comments or objections with the LOCAL GOVERNMENT CAMA Minor Permit Program, you may submit
them to:
LPONAMETvX u
Local Permit Officer for LOCAL GOVERNMENT
LOCAL GOVERNMENT ADDRESS
CITY, STATE, ZIP CODE
Sincerely, --,Coverage Provided)
' •
puEIPT
Property 6wner m
co
ru
Mailing Address :I -Postage $
ru 60&,
q;iv, Certified Fee
� Postmark
City, State, Zip Code p Return Receipt Fee Here
p (Endorsement Required)
0 Restricted Delivery Fee
CJ (Endorsement Required)
rq
C3 Total Postage & Fees
r-R
Sent To �V�U t� 1 �:_'_` !-'-SC'fJ ��,
ru111��t�1�J %�'' •--
St PO Apt. No.; ! Kam/ Nn
or PO Box ...No. J _ _____________
City, State,21P+4j' /l Jam; � /" : a 9
:rr rriZ l� c+ I

ADJACENT RIPARIAN PROPERTY OWNER
STATEMENT FOR CAMA MINOR PERMITS
I hereby certify that I own property adjacent to ld i cMJ�25�i� -s
(Name of Property Owner)
property located at aW'� �� �. �1.7(S
r� Address, Lot, Block, Road, etc.)
on t 4_z�ti �J�)'Lt'�� inb(�i� N.C.
(Waterbody) (Town 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)
Signature
Print or Type Name
Telephone Number
Date

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ADJACENT RIPARIAN PROPERTY OWNER
STATEMENT FOR CAMA MINOR PERMITS
I hereby certify that I own property adjacent to
property located at �1 L r
on
(Waterbody)
in
me of Pr Owner)
lick, Road, etc.)
(Town and/or County)
N.C.
t�0
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.
PLICATION AND DRAWING OF PROPOSED DEVELOPMENT ATTACHED
�J' 41iW.{v
Signature
Print or Type Nam
�5? S- -r. o q--- Zo � z4
Telephone Number
l�o2U/�
Date
RECEM
DEC 16 2013
DCMMHDCT Y

Anthony D. French Real Estate & Development, LLC
501 Two Lakes Trail
New Bern, North Carolina 28560
[phone]
[e-mail]
December 6, 2013
Mr. & Mrs. Lyman P Partin
249 Shell Landing Rd.
Beaufort, North Carolina 28516
Dear Mr. & Mrs. Partin
Enclosed you will find the proper documents required by CAMA when filing for a CAMA
minor permit. Mr. & Mrs. Amerson are the new owners of 241 Shelling Landing Lot 21.
They wish to construct a new residential dwelling and detached building on the property.
Included with this letter is a plot plan showing the proposed location of the structures to be
built on the lot. Please take the time to review the enclosed documents and return them to the
CAMA office in Morehead City as soon as possible. Also included is a self-addressed stamped
envelope for your convenience.
Should you have any questions please call Gary Amerson at [phone] or Anthony
French at [phone]. Thank you for your cooperation.
ncerely,
Anthony Fre ch

Receipts for
Certified Mail
4 3O I (Staple Here)
a1— 4nrlt �d J��,4%,,t�:
Ad ent Property Owner
t_� 5-U
Majlin AC� 028 Jr � �
City, State, Zip Code
Dear Adjacent Property:
This letter is to inform you that I, =� Pb'�'�E',t)JO have applied for a CAMA Minor
Property Owner
Permit on my property at ' 5K-_L1-1 L4na-i%n3n gg in COUNTY 014'ZT_0202- ti
Property Address
County. As required by CAMA regulations, I have enclosed a copy of my permit application and project
drawing(s) as notification of my proposed project. No action is required from you or you may sign and return
the enclosed no objection form. If you have any questions or comments about my proposed project, please
contact me at e "2� 1 ` ) I z (' or by mail at the address listed below. If you wish to
Applicant's Telephone
file written comments or objections with the LOCAL GOVERNMENT CAMA Minor Permit Program, you may submit
them to:
LPO NAME
Local Permit Officer for LOCAL GOVERNMENT '=' ��� ° k
LOCAL GOVERNMENT ADDRESS
CITY, STATE, ZIP CODE
Sincerely,
Property wner
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Mailing Address `O
N
City, State, Zip Code M
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U.S. Postal Service TM
CERTIFIED MAILTM RECEIPT
(Domestic Mail Only; No Insurance Coverage Provided)
Eent-----------------Apt. No.; q��,Box No. exL l eut�ta.- -•--•--
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ni

ADJACENT RIPARIAN PROPERTY OWNER
STATEMENT FOR CAMA MINOR PERMITS
I hereby certify that I own property adjacent to's
(Name of Property Owner)
property located at a�'� � 1-Acsb)QX5
Address, Lot, Block, Road, etc.)
on �� �� Z� in L--AOI IIt ✓ , N.C.
(Waterbody) (Town 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)
Signature
Print or Type Name
Telephone Number
Date

ADJACENT RIPARIAN PROPERTY OWNER
STATEMENT FOR CAMA MINOR PERMITS
I hereby certify that I own property adjacent to h o s
(Name of Pr Owner)
property located at �' �' i S -, v / �T KC S �j
Ad r /s, L bck, Road, etc;)
on in i t�?j]_J N.C.
(Waterbody) (Town 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)
Signature
Print or Type Name
Telephone Number
Date