19-22_Minor Permit_20220822

Locality _j r kS W + c. k (i MgAh Permit Number ��_
Ocean Hazard Estuarine Shoreline ORW Shoreline Public Trust Shoreline Other
(For official use only) Tax PG r L o I# x 3 3 L'A Q 18
GENERAL INFORMATION
LAND OWNER
Name i iar�•�'� �-��:t/'bt-�,+_
Address fa' iV'(
City 'c4ri �; �v I/;� p., ,Z j.��U`lUv✓%Li
�� State Zi d Phone
Email �t i'caJ� i Z' rti i ,�YXa
AUTHORIZED AGENT
Address
City
Email
State Zip Phone
LOCATION OF PROJECT: (Address, street name and/or directions to site. If not oceanfront, what is the name of the
adjacent waterbody.)1,o4tvGyal IVfv�/0�
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DESCRIPTION OF PROJECT: (List all proposed construction and land disturbance,) :1
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SIZE OF LOT/PARCEL: !� �� square feet �: 3 �'/ acres cjy�"
PROPOSED USE: Residential ❑ (Single-family ❑ Multi -family ❑) CommerciaUIndustrial ❑ 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 X
If yes, list the total built upon area/impervious surface allowed for your lot or parcel: square feet.
RECEIVED
AUG 2 2 2021

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)
1_an owner or record title, Title is vested in C tri , s r + ar i f . ' Jr < k , see Deed Book hp x
page L�W" in the wi r'r_; n<, w: , 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.
(Name)
(Address)
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(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 day of `= s , ,- t , 20 .t,:
Landowner 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 $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 212022

Excise Taa: EXCISE
NIIIIIIIII I�IIIIIIIINy. IIIi�llllnr a meku;�;g "
Brenda R. Clemson Rogister of Deeds
87-18-2022 25:03:52.800 llrune lok County, RC
NC REVOM STAPP: $800.00 (8834380)
Mal Res, .$sue•=� IM.�_.
Cash $ Finance
.8 Portions or document are illegible due to condition
�f Uniiine!.
G Immnon: Cooi'% seas verified by original
I....... ..;Aanot bo reoroduced or copied.
NORM CAROLINA GENERAL WARRANTY DEED
by and bemeea
GRANTOR GHAT
Apd ScaB , Sir?
.))e Ctmics T. HodU mad wile
Cad Hxnan , ,rs jar CanilynH. Hadra
qs aq W- e Nw SMA4'
Wa\nuF Ceare.wlc. a'405a
BaaaLappapiareWmk for aaW (Amaar a$iG�ara eame,aWling addroar,aad, qT appsopriare, clresearr afeadty, e.g
°gip•
ThedeaMu aGraotorand(Jmmemuecdb"nshall iochi&s idpararm,tbechmmmwcasaoa.andassigns,aedshoUWckelemngular,
pBoal, vumiBne, Duainim or neater as required by enomxt.
W17MMM'R, that tM Greener, tie a valuable comidmaimpaid hythe ()mate,, the reeeiptofwhidnis hmeby a insowlalged.6asaod by
tbnreprenemadood gnat, bargain, sell �caateyesto De (homers in feesinrpla, isnow orruin ku, famel Mlaugareandoedeieffinat
loek"WF* .Township,.. .. BoRBN'k$_____Camty,
NanACaraiaa and moon partisarLrgy damped m dailews:
SxamcheitIMMA
1Hf RMRUhff 1'FREBiR®BY: JAMESRFREVATI'E,JR, afcomedNotPoCualimoMmy. DebxWaYres,d'aay,Hbepaid
by tiro ekaeg as�rrey b En Bmmwid: CaKyPmc O� npoo dvt�aanmt of c3airg poc�dt
The property hwaoabow desreibed was acquired by Grantor by iost union mccided in Book page
AB m a portion tithe property hisain conveyed _ inabu es of X does awl inckuk the primary residence of a Grealor.
A nap showing the above domedbcl property is recorded in Plot Boot page
Pye 1 of 2
NCBerAeockiaa Puns Nn 3019T0,Itevirrd0jTn,2e10,30e3Ibis aboderdt sallies povrd by.
PdradbyANs s1r4OANCEwArrodWm-1981 Noah CsoBmB.AancYOm-NC Bu1PemNn3

TO HA YB ANDTO HOLD the afon=J d lot or parcel of sand and allpAvi leges and apptuteoa=s thereto belonging to the Grantne, In fee
siavlo.
And the Chasnot caaemm s vAth the GranbM that Grsotor is waned of the p rusts to tee simplo.has the right to ooeM ibe tame in fee
simple, that title is marketable and Glee and Clear of all coca braw*s, and that Granmr Will wwrAnt And defend the title against the lewfnl
claims of all pesaooa ahoMMMvQ, other than Cho fDHO Vnog esae aGM
IN %TlTI#iSS W WEOF, the Grantor has duty executed the toregoing as of the day d year first above written.
MAD
-- ^ — (FtttityName) —'— ypc Nance. A�h1Swk
Ptintflype Name & Tirlo: Fdaftype NHMff.UCWJBMMUMKL—
By: -------Uama
Pnatllype Nam & Title-_ PtWlype Name:
Priaiflype Name &
State of Slab Ca ofma - cot,nty or city of _
I, the undersigned Notary Public of the sty or
ezecutioa eggoii`ngg instntment tar the lvngx os xhe
My Comrsission ice: {
{Affix Sean
Pria9l'ype Name `
tmarlEk r t�
:ice— ;TAle aforesaid, testify that
Fi otafly appeared before me thin des and wkaowledged the due
my hand and Notarial s mp or this jS!�day of
NOT�Y
puBUG 2 �� a'l.S..kLL Notatypabli.
Notary's Priated or Typed Nacre
State of. NO& carolirs_ _ - county or Oty of
f, the undersigned Notary Public oftiK Qnh &Ly ur ty of
My Commission Fsptms: .
(Affix seal)
-------County or Cityof
1, the undersigned Notary Public of the Courtty or City of — and State aforesaid, cetafy that
-- _ petsoaalty cane bedure the thin day and acimorvadgeed that
Jus is the of _ - a Borth Carolina or
calf otatioa4ia ted fiabiiity cntt;-)1& ahaal P ad Partnership (Mke thma the
inspplit:abte), and that by authority duly given and as the act of such amity, Jae signed the foregning inaanment in its tame on its.
behalf as its act and dee dL Witness my bsed sad Nonnat staff or seal, Chia day of _ 20—
k C AkaB1 I fs<dS4atnsfornsatil. certify tW
sonally appeaed betare me this day and acim wkiged the due
itacss my hand and RtM;AjgL up=V4wrnmmQa_ day of
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f'itv"', MS(eit_..-_ Notary Public
Notary's Prbded or Typed Name
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(Affix Seal)
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Notary's Printed orTyped Fume
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NC Bar A= -Wm Pan& No. 1-&6 daod" form tan ten appt®.. d by:
t41aa d by Amerced with" NC Bar.tsssmtoo-19a1 North 0, dit sae Awo"im - HC 11w iRsm No.3
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Brunswick County, NC Racistar of Dasds pace 2 of 3

IIIII III IIIIIIIIIIIIIIIII,I�IIIIII B4884138 0:62 W0
Brun iok Cou ty, oBLlor of Doodo Pa90 3 of 3
Exhibit A
Tract One:
BEGINNING at a large forked Live Oak marked on the South side with a blaze and
3 chops and on the North Side marked US and runs thence South 17 degrees West
300 feet to an iron corner at the edge of the Inland Waterway; thence West with the
Inland Waterway 86 feet 4 inches to an iron pip; thence North 17 degrees East 300
feet to an iron corner, thence North 76 degrees East 86 feet 4 inches to fast station,
the point of Beginning, containing 1 lot. Being the same as conveyed to Garfield
Clemmons et.al by deed dated August 5, 1936 and recorded in Book 72 at page 177
in the Office of the Register of Deeds for Brunswick County, North Carolina.
Track 2:
Beginning at an existing iron pipe, the NE Corner of Lot 22, Block A, of Howell's
Point Development; said beginning corner being located N 87 degrees 16 minutes
13 seconds West 115.03 from a railroad pike located where the centerlines of
Lockwood Folly Road, SE intersects with the centerline of Sunset Harbor Road, SE,
thence from the point of beginning S 76 degrees 20 minutes 42 seconds East 59.96
to a point, the NW comer of the above described Tract One, thence leaving said
point and going with said western property line S 16 degrees 57 minutes 49 seconds
West to the High Water Mark on the Intracoastal Waterway, thence with the high
water mark in a westerly direction 55.20 feet +/- to a point in the high water mark,
thence leaving said high water mark and going along the eastern property line of Lot
22, North 8 degrees 17 minutes 31 seconds East to the place and point of beginning.
Being the same as conveyed to April Scott in Deed Book 4852, Page 1275 and as
conveyed to H.A McCam and Annie Irene McCain in Deed Book 87, Page 228 and
as conveyed to May Atkinson in Deed Book 63 at Page 367 of the Brunswick County
Registry.
The Estate of Hubert Ancel McCain recorded in Estate File 22E1070 of the
Brunswick County Clerk of Court;
The Estate of Irene McCain Patterson is recorded in File #22E1071 of the Brunswick
County Clerk of Court;
The Estate of Mary Ellen Freeman is recorded in File #22E1072 of the Brunswick
County Clerk of Court;
The Estate of Ronnie Ellis Freeman is recorded in File #22E1073 of the Brunswick
County Clerk of Court

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Henry Wastewater Services LLC
426 Red Fox St
Shallotte, NC 28470
[phone]
To whom it may concern,
Henry Wastewater Services located and marked the septic system located at 477
Lockwood Folly Road Bolivia, NC. The septic tank is located on the right side of
the house 12 feet from the house. The drainage line is 30 feet long going directly
toward the street and ends 10 feet from the property line. The line is 67 feet from
the front right property line. Attached is the plans showing all of the details.
Sincerely,
Matthew Henry
Licensed Septic Installer Grade IV
Henry Wastewater Services
[phone]
[e-mail]

,
�>—ri --LZ
Date
Adjacent Property Owner
,7, Lvc.kL . __4 It , s
M//�a1iling Address
em u _ -1 i L 2. Z.
City, State, Zip Code
Dear Adjacent Property:
Receipts for
Certified Mail
(Staple Here)
This letter is to inform you that I, �ke, NI eh W eAP1,`Jc— have applied for a CAMA Minor
! j Property Owner n `
Permit on my property at i7��C U Y�7 F , U r CL kC /�f&in Brunswick
(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 33 f,,, q 0 7 - --Z 3 J, p , 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:
Sincerely,
Property Owner
Mailing Address
City, State, Zip Code
Connie Marlowe
Local Permit Officer
Brunswick County Planning Department
PO Box 249
Bolivia NC 28422

of �
Date
Adjacent Property Owner
s I d j. _�
Mailing Address
NC 2; _S"3
City, State, Zip Code
Dear Adjacent Property:
Receipts for
Certified Mail
(Staple Here)
This letter is to inform you that I, 01v r 1 e g - "�e-J r have applied for a CAMA Minor
Property Owner
Permit on my property at Jr7r7 Li)c-kt,:ocj +—•I f 6cJ %- q; c` jJ( )YyZZ in Brunswick
(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 3 3 4e�,�aC
2 , or by mail at the address listed below. If you wish to
Applicant's Telephone
file written comments or objections with the Brunswick County CAMA Minor Permit Program, you may submit
them to:
Connie Marlowe
Local Permit Officer
Brunswick County Planning Department
PO Box 249
Bolivia NC 28422
Sincerely,
Property Owner
Mailing Address
City, State, Zip Code

Project Number
Payment Date
Payment Method
Payment Amount
Check Number
Permit Number
Brunswick County Central Permitting
75 Courthouse Drive, Bolivia, NC 28422
[phone]
Receipt for Permits / Planning
544471
8/22/2022
CHECK
$100.00
1038
Description
CAMA Fee - Budget Line Item Number: 383912
Permit Amount
$100.00
Total $100.00