18-22_Minor Permit_20220824

Locality
Zr U-As J,'ck
Permit NumberR:) a ` I
Ocean Hazard Estuarine Shoreline °� ORW Shoreline Pub lc Trust Shoreline Other
(For official use only) Ta (� y a N Du o 10 a
GENERAL INFORMATION
LAND OWNER
Name G lrw 5+et Ida 5 cn
Address 3 116 6 e &,,- r C- Kee—lk L-a-n ,
City Ca�& JI rub- 65hcyres State /\/& Zip29YG7 Phone 9% 97
Email G b cx. InSc n ID k k h .S G PP , conl
AUTHORIZED AGENT
Name hee � 4, AG w e -ff Zt:?lle-f 6& ,4
Lr ,
Address 12 q7J `
City`'l�l �r"� State L Zip ZVY5/Phone `"�/a 7' `�7-�
Email L 16171r A A o h111d,�tf5- 7 1014
LOCATION OF PROJECT: (Address, street name and/or directions to site. If not oceanfront, what is the name of the
adjacent waterbody.) 21,) e -`(Me Jf "�. d e-e <-z /S to A -I,(-- :,� t 4- 15�"
1 nA-f-z-� G-& At-5+eA I V/ 4. �fi ir-r=cV bG . I d ��� ��r p
DESCRIPTION OF PROJECT: (List all proposed construction and land disturbance.) 110
5ftgas anP'
SIZE OF LOT/PARCEL: square feet acres
PROPOSED USE: Residential D (Single-family �Muiti-family ❑) 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 AEC$: 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: "quare 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 js ed by the NC Division of Water Quality?
YBS NO
If yes, list the total built upon area/impervious surface allowed for your lot or parcel: square feet.
RECEIVED
AUG 0 12022

OTHER PERMITS MAY BE REQUIRED: The activity you are planning may require permits other than the CAMA
minor development pen -nit, 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 15 �_t? 1 (15V see Deed Book
page ��'3 in the �w JGIC Co�egistry of Deeds.
an owner by virtue of inheritance. Applicant is an heir to the estate of
probate was in
County.
12�Cif other interest, such as written contract or lease, explain below or use a separate sheet & attach to this application.
A . L, cz
v r� rr'
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.
(1)
(2)
(3)
(4)
(Name) (Address)
C fll d K / n1 b We-Lk,?Co -4
R"A u S Lenka , � t r) 41 > ,.�►a.� �l. �'., �. Z4 < ��l1�3c_ 0' 4 `� G
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 ine 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, pennission to Division of Coastal Management staff,
the Local Pen -nit Officer and their agents to enter on the aforementioned lands in connection with evaluating information
related to this permit application.
Ell
This the 74k day of ILA I , 20 ? Z
Xkl,Mld'e'�, /,7G. A64P-PT
Landowner or�6rson authorized to act as his/her went 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 checkfor $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.
RECEIVED
AUG u 1 2022

DwuSign En"lope ID: 6F4372F4-1 B984B3D-82E0-34B125E70B98
AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: l.. r !� S f w / 13ah'sipfN
Mailing Address: 3 % ed A.- Lea -k LeC.s�
NG 7- 4G7
Phone Number: /'!� 3 9.3 qq 5 "7
Email Address: ';� b A A 02 �r✓1
I certify that I have authorized Meflci f f &� /f
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
bnecessary for the following proposed development: ti.r l d- Li. SFx-
at my property located at -2�.9 Z 1 Curtc:' b*- t7�i✓G , fileg*n /S te
in Fy-"s County.
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.
Property Owner Information:
(yt�6L 13abW,
rc�
Signature
Crystal Babson
Print or Type Name
owner
Title
7 1 11 1 2022
Date
This certification is valid through t•,;1, 13) 1 2`D2,3

Brenda M. Clammm Register of Ouch
10-14-2020 13:30:47.000 Brunaslek County, NC
NC REVENUE STAMP: $420.00 0713007)
IIIII'11.�lllll lllll'IIIIII MIIIIII BM
11. Cle'15A 47000
mamap
Brurwlck Canty, RC R"ister of 0aade ears 1 of 3
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ntel, fie", Irt.y_
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insirumari thai cannot be re,:maucec a cuprea.
This instrianent prepared by. David L. Worunan, a licensed North Carolina attorney. Delinquent taxes, if my, in be paid by the
closing attorney to the Brunswick County Tax Collector upon disbursement of closing proceeds. No title opinion or closing
services tendered by prepater.
NORTH CAROLWA GENERAL WARRANTY DEED
Excise Tax $420.00
Parcel identifierNo. 2A2MD00102 Vedfred by County m the— day of
By: , 20_
to:
Suite
Thin instrument was prepared by: The Wortmen Law Firm, PLLC, 624 Villuge Rd., Suite 1, Shallotte, NC 28470
Brief description for the index: 014 AC. PL 106/97
THIS DEED made this -0_ day of OCt • 20 7A , by and between
CHARLES BERNHART JORDAN & wife, CRYSTAL BAR", unmarried
MARGARET P. JORDAN 3116 CedarCreek lane
612 Lakeside Drive Carolina Shores, NC 28467
Conway, SC 29526
Enter in appropriate black for each party: anent, address, and, ifapprgxicty character of entity, e.g, corporation or patmerahip.
The deelgoatim Greener and Grmtce as used herein shall include said parties, their heirs, successors, and assigns, and shall include
singular, plural, masculine, feminine or newer n required by content
WITNESSETH, 0mtthe Greater, fora valuable emsideretion paid bythe Grantes, the receipt ofwhich is hereby adomwkdged, has and
by dim presents does grant, bargain, sell and convey man the Gnuree in fee simple, all dust certain lot or parcel of land situated in the
City of ShaBolte Township, Brunswick County, North Carolina and more particularly described as follows:
"SEE ATTACHED"
The property heteinsbove described was acqubed by Grantor by restatement recorded in Book 4048, Page 738. s's'
All ora portion of the property banal, conveyed _ includes or vld. not include the primary residence of Grantor. I

NIIIIIIIIIII�illlulillll�ll9IIIIII
Brunaulek OohahtY, NC alstar of 0aads'?4papa 2 of 3
A map showing the above described property is recorded in Plat Book 106, Page 97.
TO HAVE AND TO HOLD the aforesaid lotorparml ofland and all privileges and appurtenances thereto belonging to the Grantee in
fee simple.
And the Grenmrcovenautswith the thanks,that Gmtoris mind of Me premises in fee simple, has the right to convey the same Afee
shnpie, that title is marketable and free and clear of all encumbrances, and that Grentm will warrant and defend the ride against the
lawful claims of all persons whomaoaver, other than the fbilming exceptim:
Subject to Restrictions, Easements and Right of Ways as nary eppem of record.
IN WITNESS WHEREOF, the Grantor has duly erecoted the £ongoing as of the day end yam Erg above written.
(S
Ohades B�ero-harrt Jordan
Ohl t �(S1
Ma are P. Jordan
I. the undersigned Notary Public, modify thetCharlp BernhartJordan and hLrgaratP. Jordan pason913fpprp'np�{befog
me this day And adahowWited[he dueexecation oftheforWiog mahronan[forthepurposes therein ezM,,,. yf xy
Notarial stmnp or seal this �'S day of Oclabv ,ZOap ob-;bera
My Commimim Expires: S, 3 o
TheforegoingCetifhcale(a) of is/an
certitodmbe mrsect. This bubtanmt end this cmtdrrate me duly raghaterM m Me date and time W hh McBook and Page shownm dw
Fort page hereof
Register of Deeds for County
By: Deputy/Assistant - Register of Deeds

IIIIIIINIIINnlllulllllllliqul a ?� w' � erunwlek Ceunly. NC ROeloler of lr- i- "go 3 of 3
PROP
ATTACHMENT
BEINGAII ofthatoNtain 10397.3eq Rparaelaeshovnon'Bor dmySmWofTm Panel Na 242MD001D2 Charles B. Jordan
Lawrence & Kake Thonpsul Owner recorded In the OMee of to Brure vkk Crxs* Regiskr of Deeds in Map Cabinet 106 at
Page97, reface to which is hereby made for greateraafainly of description
Mae omnoNy known w 203 CameldDrive, Oceen We Beads NC 2M (PIN: 242M000102)
BAB"74M
202e GlmbtG .Ovw kb 8e8rh�NC28489

t.ECElVED
A06 "I Im.
LOCATfON MAP (No scale)
s�eun
O NIR N[w kfBV2 DET
FIR C[ExiiiSTiNG IF0. POUND
XMOCONGRETELCOIRROL MONUMt 5P1
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fMPERV10U5 CALCULATIONS
IMPERVIOUS AREA
"CU5E 1907 5F
TOTALIMFEKVIOU5 IN AEC 1579 S
28.8 %
TOTAL AEC AREA 5453 5F
LOT AREA 10.3GA 5P
PROPO5I=P 51rE PLAN FOR Im
OMPKI N5
LAND
5UR
Crystal Babson SURVEYING
P.A.
OF 136E RIVPR BEND DRIVE
MCIP05ED 51TE PLAN FOR sH NORrn cARouNA Zino
2028 CANIELOT DR5W
MG 1 OG-PAGE 97
SHALLOTTE TWP BRUN5WICK COUNTY. N.C.
5CALE !'y 30' DECEMHER 15, 2020
REVI5ED JUNE 24.2022 POK NORMAL HIGH WATER
REVISED JULY 7.2022 FOR 51TE PLAN
O 15 30 GO
EUWARU IMDRDC440
MC 45-PAGE 3G
NOTF5
I AREA 8Y COORDINATE5 .
2 PROPERTY 15 5IJDJrCT TO ANY AND ALL RE571RICTIVE COVENANTS
EASEMENTS AND MINERAL RIGHT5 IF APPUCABI.E AND
KECORPFU W THE BRUN5WICK COUNTY REGISTRY.
s PROPERTY 15 LOCATED IN A V� ROOD ZONE.
4 IRON ROP5 PLACED AT ALL CORNERS UKLE55 OTHERWI5E NOTED.
5 PROPERTY SUBJECT TO ALL ZONING REGNIREMENTS OP
,,RUN
COUNTY N.C.
6 ELEVATION DATUM NAVO 1988
7 TYI15 5URVEY REFLECTS AN A55UILT OF TH15 PROPERTY A5 Of THE
DATE OF 51GNATURF.
8 TH15 5URVEY DOE5 NOT CEKTIPY LEGAL TTLE TO THE LAND ITSELF,
OR TO THE BOUNDARIES SHOWN. U5ER5 OF 7HI5 PLAT 5HOULP
OBTAIN AN ACCURATE LEGAL OPINION A5 TO OWNERSHIP TO THE
BOUNDARIE5 5HOWN"TNi5 PLAT.
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I. JAME5 R. TOMFKIN5 A RE05TWU LAND 57JRVEYOK
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CERTIFY THAT THE RATIO OP PRECISION 15 11, I OGOO
AND THAT TM15 MAF MEET5 THE MINIMUM STANDARDS OF PRACTIC
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FOR EPN❑ 5URVEMNG IN NORTH CAROLINA.
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ITIT COMPNTfR FILE
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File No.: 2006068042A Type: %/ C—
BRUNSWICK COUNTY HEALTH SERVICES
Post Office Box 9 BOLIVIA, NC 28422 [phone]
IMPROVEMENT PERMIT
PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE
An Authorization for Wastewater Construction must be attached to the Improvement Permit before an
other permit can be issued and before a wastewater system can be installed.
Supporting documents such as the completed application form, site evaluation form, fill plan, etc. are considered
a part of the Improvement Permit.
Owner's Name: THOMPSON LAWRENCE H Sr KATIE H Tax Parcel 242MD00102
Lot s: 82 Block: Sec 3 SUBDIVISION MARLEE ACRES
Residential: X Water Supply: Private (well) X Public
No. of units: 1 No. of bedrooms 4 No, of occupants 8
Commercial: Type of business: No. of Employees:
---------------------------- ----------------------------------------------------------------------------------------------
Size of septic to//nk: U 0 O / � gpd/sq.ft. Drainfield sq. feet:, 2
No. of Lines_ Length ea.:J e Trench width''`---r Bed : zC 3Dt-sign Flow gpd:
�Trenchl Bed bottom depth no dee er than �" � r� inches Pump tank volume:
01Z-Z6 r�� �j_..—���l-� R)�L- (if applicable)
if applicable, the following conditions must be met prior to issuance of an Authorization for Wastewater
Construction and prior to wastewater system installation.
X Keep 100 feet from all water supplies (minimum of 50 feet must be maintained).
X Keep 10 feet from all water lines,
X Keep 10 feet from any property lines (no less than 5 feet for lots recorded prior to 7/1/77)
X Do not drive over, park, pave, or build any structure over the area for the septic tank system and the repair
area if applicable.
X Do not install the septic system during wet conditions.
X Maintain Gravity Flow for septic system.
Drainage Maintenance Required.
Suitable Fill material must be installed exactly per the Health Services Department approved fill plan.
Fill check must be completed by the Health Services prior to issue of Authorization for
Wastewater Construction Permit.
Approved for use of Alternative/Innovative Wastewater System (Specify)
_ Submit Wastewater plans to the Health Services for review/approval
X If Septic System Uses Rock Aggregate/Approved Filter Fabric Covering Required
X Septic Tank System must be installed per the Construction Authorization Permit.
X An "accepted" system may be used in the place of a "conventional" system.
X The construction authorization cannot be issued until final storm water plans are received from the
applicant. The applicant is responsible for notifying the health services department if any changes are made to
the storm water plan and, if so, what those changes are. A letter from the engineer responsible for the storm
water plan with the engineer's seal identifying the changes shall satisfy this requirement.
IMPROVEMENT PERMIT ISSUANCE DATE: p Z. 9 EXPIRATION 03AFZ s�
This permit expires 60 months from the date of i4suaria unless otherwise specified
Permit Not Valid Unless Signed by Authorized Agent:
Signature
Actions of Brunswick County Health Services representatives engaged In the evaluation and determination of measures required to
effect compliance with the applicable laws and rules shall in no way be taken as a warranty that sewage treatment and disposal systems
approved and permitted will function In a satisfactory manner for any given period of time. Permit Is subject to revocation if the site
plan or plat whichever is applicable, or the Intended use changes.
The issuance of this permit does not preclude the Permittee from complying with any and all statutes, rules, regulations, or ordinances which may
be imposed by other government agencies (local, state, and federal) which have jurisdiction.
SEPTIC TANKS SHALL HAVE AN APPROVED EFPLUENT FILTER & ACCESS DEVICES
Rev: 04/10/13
Updated 01/0812008

DATE REC: 03/1112016 BRUNSWtCK COUNTY HEALTH SERVICES FILE NO.: 2006068042A
ZONING:
THOMPSON KATIE AND HANK THOMAS $0.00 242MD00102
REC. FROM AMT. PAID TAX PARCEL
505 VINELAND ST WHITEVILLE NC 28472 9102345540
ADDRESS CITY STATE Zip CODE PHONE
THOMPSON LAWRENCE H ETUX KATIE H 82 3
CURRENT PROPERTY OWNER LOT BLOCK SECTION
PROPERTY LOCATED TOWNICITYIAREA: CO SUBDIVISION:
DIRECTIONS; 2028 CAMELOT OR SW 28469 -17S TO 179 TO CAMELOT APPROX 112 MI FROM 904
AUTHORIZATION FOR WASTEWATER CONSTRUCTION PERMIT NOTES
NEW: REVISIDN: RELOCATION: REPAIR:
1. Septic Tank shalt have an approved
Design Flow; 9pd Septic Tank Size: / gal Type: effluent Titter and access devtces as
J applicable.
No. Bedrooms: _ No. occupants/employees Max 2. Maintain all setbacks distances for
fC `` C / � d FL' septic tank systems and wells.
T renchlBed Bottom Depth: Inches: 13 .Cc9 c-tom !� �� 3. All components of the septic systems
P shall be located 100 feet from well.
j _ r-/ 4. An "Accepted" system may be used in
No. Lines: Length Each; Bed Dimensions: ,z 'L c� the place of a "conventional" system.
Fill Check, A—./ Q Approved: A,/ C�(_
Date Authorized Agent
PERMIT ISSUE DATE: Permit Expiration Date: 03 �� Z Q
Authorized Agent: _ -� �!C L,L��7 _ Registration: LE
F I I I T— t �. , l T—T�e✓�O %r �O
NOTE: PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTEN ED USE CHANGES.
L4--4-1,�
—1._-L -.-L- -L 1 l. 1 a 1. I-_.L
Waste Water Sy tem Installer:
Comments: (tank info/ barrier approved)
Rock: Polystyrene Aggregate
OPERATION PERMIT'
Chamber.
Authorized Agent Signature
r
U
�Q �-'f "Jet -lb -'%
Date:
Date:
Either:
Actions of local health department representilives or the State engaged in the evaluation and determination of measures required to effect compliance with the
applicable laws and rules shalt In no way be taken as a warranty that sewage treatment and disposal systems approved and permitted will function in a satisfactory
manner for any given period of time. This issurance of Us permit does not preclude the Permittee from comploying with any and all statues, rules and regulations or
ordinances which may be imposed by other government agencies ( local state, and federal) which have jurisdiction. /
r _

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DearAdjacent Property: Jan+
This letter is to inform you that I, vei+ have applied for a CAMA Minor
operty Owner
Permit on my property at g C ..croe l lot D n ,),e, in
COUNTY Property Address
Brunswick 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 q10 oZ-771 5135 or by mail at the address listed below. Nyou wish to
Applicanfs Telephone
file wriflen comments orobjections with the Brunswick County CAMA Minor Permit Program, you may submit
them to:
Connie Marlowe
Brunswick County Planning Department
PO Box 249
Bolivia NC 28422
Sincerely,
Prope y Owner
12011" ZZLf7
Mailing Address
6 Au /I a r Ne- 99q-5e7
City, State, Zip Code

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r `" Date
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Adjacen Property owner
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Dear Adjacent Property: //// rAe�
This letter is to inform you that I, kp jru Ab'y t have applied for a CAMA Minor
Property Owner
Permit on my property at j &-F Pr, ,/ in
COUNTY PropertyAddress
Brunswick 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 oryou may sign and
return the enclosed no objection form. Ifyou have any questions or comments about my proposed project,
please contact meat 9roas� 35 or by mail at the address listed below. If you wish to
Applicant's Telephone
file written comments or objections with the Brunswick County LAMA Minor Permit Program, you may submit
them to
Connie Marlowe
Brunswick County Planning Department
PO Box 249
Bolivia NC 28422
Sincerely, `
, 64�4
Property owner
R 0'e'y *ZZ'So7
Mailing Address
City, State, Zip Code

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Project Number
Payment Date
Payment Method
Payment Amount
Check Number
Permit Number
1000
Total
Brunswick County Central Permitting
75 Courthouse Drive, Bolivia, NC 28422
[phone]
Receipt for Permits / Planning
542161
8/1 /2022
CHECK
$100.00
1076
Description
CAMA Fee - Budget Line Item Number: 383912
Permit Amount