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HomeMy WebLinkAboutSB_16-05_Long Leaf Pine LLCTown of Sunset Beach SB 16.05 Local Government Permit Number CAMA MINOR DEVELOPMENT PERMIT as authorized by the State of North Carolina, oeparbnent 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 Long Leaf Pine, LLC, authorizing development in the Ocean Hazard (AEC) at 1839 East Main Street (Palm Cove Lot #4), in the Town of Sunset Beach, as requested in the permittee's application, dated December 2314, 2015. This permit, issued on January 19r", 2016, 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: Fill and grade (1) All proposed development and associated construction must be done in accordance with the permitted work plat drawings(s) dated received on December 3151, 2015, (2) All proposed development and 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. If any provisions of the building code or a flood damage prevention ordinance are inconsistent with any of the following AEC standards, the more restrictive provision shall control. (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 910-579-0068 for a final inspection at completion of work. (Additional Permit Conditions on Page 2) JAN 1 b 20116 This permit action may be appealed by the permitlee or other qualified persons within twenty (20) days of the issuing date. This permit must he on the project site and accessible to the permit officer when the protect is inspected for compliance. Any maintenance work or project modification nor covered under this permit, require further written permit approval. All work must cease when this permit expires on: DECEMBER 31, 2019 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. Richard Hathcock CAMA LOCAL PERMIT OFFICIAL 700 Sunset Blvd. N. Sunset Beach, NC 28468 PERMIT EE (Signal a required if conditions above apply to permit) Name: Long Leaf Pines, LLC Minor Permit # SB 16.05 Date: January 19th, 2016 Page 2 (5) Dune disturbances will be allowed only to the extent necessary for development and if the dune's protective value is not weakened or reduced. Disturbed dune areas will be immediately stabilized. (6) All unconsolidated material resulting from associated grading and landscaping shall be retained on site by effective sedimentation and erosion control measures. Disturbed areas shall be vegetatatively stabilized (planted and mulched) within 14 days of construction completion. (7) Any new dunes established shall be aligned to the greatest extent possible with existing dune ridges and shall be of the same general configuration as adjacent natural dunes. (8) Existing primary dunes shall not, except for beach nourishment and emergency situations, be broadened or extended in an oceanward direction. (9) Adding to dunes shall be accomplished in such a manner that the damage to existing vegetation is minimized. The filled areas shall be immediately replanted or temporarily stabilized until planting can be successfully completed. (10) Sand used to establish or strengthen dunes shall be of the same general characteristics as the sand in the area in which it is to be placed. (11) No new dunes shall be created in inlet hazard areas. (12) Sand held in storage in any dune, other than the frontal or primary dune, may be redistributed within the AEC provided that it is not placed any farther oceanward than the crest of a primary dune or landward toe of a frontal dune. (13) No disturbance of a dune area shall be allowed when other techniques of construction can be utilized and alternative site locations exist to avoid unnecessary dune impacts. SIGNATURE: DATE: alld 41 ERMITTEE AEG HAZARD NOTICE Project )s In An: Ocean Erodible Area x High Hazard Flood Area Inlet Hazard Area Property Owner: Long Leaf Pine, LLC Property Address: Lot t14, Palm Cove Subdivision, 1836 East Main Street, Sunset Beach, NC 28468 Date Lot Was Platted:. November 2004 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 Commission's rules on building standards, oceanfront setbacks and dune alterations are designed to minimize, but not eliminate, property loss from hazards. By granting permits, the Coastal Resources Commission does not guarantee the safety of the development and assumes no liability for future damage to the development Permits issued in the Ocean Hazard Area of Environmental Concern include the condition that structures be relocated or dismantled ifthey become imminently threatened by changes in shoreline configuration. The structure(s) must be relocated or dismantled within two (2) years of becoming imminently threatened, and in any case upon its collapse or subsidence. The best available information, as accepted by the Coastal Resources Commission, indicates that the annual long-term average ocean erosion rate for the area where your property is located is 2 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 as 440 feet landward in a major storm. The flood waters in a major storm are predicted to be about 18 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 sand bags may be authorized under certain conditions. The applieantmustwAmowledge this information and requirements by signing this notice in the space below. Without the proper signature, the application will not be complete. —9&2Tt_nrri 12.21-IS AppficantSignature mrt...G,(+`+.+�+- 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 work begins on the project site, the Local Permit Officer must be contacted to determine the vegetation line and setback distance at your site. If the property has seen little change since the time ofpermit issuance, and the proposed development can still meet the setback requirement, the LPO will inform you that you may begin work. Substantial progress on the project must be made within 60 days of this setback determination, or the setback must be remeasured. Also, the occurrence of a major shoreline change as the result of a storm within the 60-day period will necessitate remeasurement of the setback. It is important that you check with the LPO before the permit expires for official approval to continue the work after the permit has expired. Generally, if foundation pilings have been placed and substantial progress is continuing, permit renewal can be authorized. It is unlawful to continue work after permit expiration. For more informadon, contact. - Richard Hathhoock Local Permit Officer 700 Sunset Boulevard Address Sunset Beach, NC 28468 Locality (910)579-0068 Phone Number RECEIVED UCM WILMINGTON, NC JAN 1 2 9.016 Revised 2107 ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to Long Leaf Pine, LLC s (Name of Property Owner) property located at 1836 East Main Street, Lot 4, Palm Cove (Address, Lot, Block, Road, etc.) on Jinks Creek in Sunset Beach N.C. (Waterbody) (City/Town and/or County) The applicant has described to me, as shown below, the development proposed at the above location. x I have no objection to this proposal. I have objections to this proposal. DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT (Individual proposing development must fill in description below or attach a site drawing) WAIVER SECTION I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or groin must be set back a minimum distance of 15' from my area of riparian access unless waived by me. (If you wish to waive the setback, you must initial the appropriate blank below.) I do wish to waive the 15' setback requirement. I do not wish to waive the 15' setback requirement. (Property Owner Information) l� S n lure Lo Leaf Pine, LLC Print or Type Name 503 Olde Waterford Way Mailing Address Leland, NC 28451 City/State/Zip (910)383-1044 Telephone Number/email address 12/21/15 Dare 'Valid for one calendar year after signature' (Adjacent Property Owne Information) C • Signature* Port City Advisors, LLC Print or Type Name P.O Box 1967 Mailing Address Wilmington, NC 28402 City/StatelZio (910)540-9716 Telephone Number/email address 12/21/15 F rzC'-I\/`=-ram Date* DCM WILMINGTON, NO J A N Tels"ug- ""' 05/12/2005 08,900.00 24 xeNs sxe. TFb E T0TZRET m `G PUTAI REV=TC#�((((((yyyyyyREC#_CKAMT�K#ppppppppppppCASH_ REF_BY RoHb� obiinson Rsqaster Of Deed Inst 1265197 Book05/11/2005 01:93 50p' R21 a31 216 eCaa3ls93 Lf 6-2Slr IvLP�C>04 6—' -4 los4 _lf 55 Excise Tax: Prepared Without Op on o Parcel Number. Prepared by: Hewett law Firm, Mack Hewett Jr., Attorney at law 632 Village Rd., Ste. 1, Shallotte, NC 28470 STATE OF NORTH CAROLINA COUNTY OF BRUNSWICK = t , NORTH CAROLINA GENERAL WARRANTY DEED THIS DEED, Made this the &t day of May, 2005, by Tidal Ventura, LLC ("Grantor") to Long Leaf Pine, LLC ("Grantee'l; whose address is PO Box 1967, Wilmington, NC 28402. W1 L-9 The designation Grantor and Grantee as used herein shall include said parties, their heirs, successors, and assigns, and shall include singular, plural, masculine, feminine or neuter as required by context. WITNESSETH: THAT the said Grantor, for valuable consideration paid by the Grantee, receipt of which is hereby acknowledged, has and by these presents do grant, bargain and convey unto the said Grantee in fee simple, all that certain lot or parcel of land situated in the City of Sunset Beach, Brunswick County, North Carolina and more particularly described as follows: BEING ALL of Lot Four, Lot Seven, Lot Eight and Lot Nine as shown on a survey map by James R. Tompkins, P.L.S., entitled "Proposed Subdivision Survey for Sunset Beach & Twin Lakes, Inc. of Lots 1 thru 10, 12.67 AC Total, Located on the East End of Sunset Beach," and recorded in the Office of the Register of Deeds for Bmnswick County, North Carolina in Map Cabinet 31, Page 190 to which map reference is made for greater certainty of description. The real property described herein is conveyed together with and subject to the following: 1. a nonexclusive easement and right of way for ingress, egress and utilities over and across the property shown as "East Main Street Extension" and "20' Drive - Private" and "10' Ft. Drive" on a map entitled `Proposed Subdivision Survey for Sunset Beach & Twin Lakes Ina of Lots 1 thru 10 12.67 AC Total, Located on the East End of Sunset Beach" recorded in Map Book 31, Page 190, Brunswick County Registry, reference to said map is hereby made for a more particular description. �' E C E-i v E P"i -)CM WILMINGTON, NC JAN 1 2 2016 NCDENR North Carolina Department of Environment and Natural Resources Pat McCrory Donald R. van der Vaart Governor Secretary AGENT AUTHORIZATION FORM Name of Property Owner Applying for Permit: Long Leaf Pine, LLC Owner's Mailing Address: P.O Box 1967 Wilmington, NC 28402 Email: Phone Name of Authorized Agent for this project: Elizabeth Nelson, Cape Fear Engineering Agent's Mailing Address: Cape Fear Engineering 151 Poole Rd, Suite 100 1lelville, NC 28451 Email: elizabeth.nelson(i7capefearengineering.com Phone ( 910 ) 383-1044 I certify that I have authorized the agent listed above to act on my behalf, for the purpose of applying for, and obtaining all CAMA Permits necessary to install or construct the following (activity): Single family residence, fill and grade only Project Site Address: Lot 4 Palm Cove Subdivision, 1836 E Main Street, Sunset Beach 7 /2.21-/�� Property Owner Sig�n�at�urreDate* *This certification is valid 1 year from date signed by property owner. RECEIVE[) DCM WILM MWE[) JAIGICi"6 INGTON, NC N.C. Division of Coastal Management J AN 1 2 2t116 127 Cardinal Drive Ext., Wilmington, NC 28405 Phone: 910-796-72151 FAX: 910-395-3964 Interne(: www nccoastalmanagement.net An Equal OppMuniy 1 Afirmalive Action Employer APE FEAR ENGINEERING 151 Poole Road, SuBe 100 BeNle, NC 28451 TEL (910) 383-1044 FAX (910) 383-1045 www.mpefearengineering.com To: Sunset Beach Building Inspections Attn: Richard Hathcock/Rawls Howard ❑ As Requested ❑ For Your Files ❑ Sent via Mail ❑ Sent via Courier Transmittal Date: I December 31, 2015 File: 675-0304 "38" Palm Cove Subdivision, Lot 4 CAMA Minor Permit Sunset Beach, NC ❑ For Distribution ® For your Review / Action / Approval Quantity Drawing No. Description 1 Original Check for $100 for required Permit Fee #+E 1 Original CAMA Minor Development Permit Application 2 Copies Grading Plans 1-full size 22" x 34", 1-reduced size 11" x 17" 1 Copy Agent Authorization Form 1 Copy AEC Hazard Notice 1 Copy Adjacent Riparian Property Owner Statements, from Lot 3 & Lot 5 property owner 1 Copy Property Deed REMARKS ' Permit for Fill and Grade Only CC: File 675-0304-"38" Date: Engineering, Inc. i1�117�9r11U71t@l�ll� � %i UN W015 Fil aM Gr 02015-12-23 88 Tta11SMiRai.E APPROIB.NIE LAIR OF MMN FIRST LIE DP STABLE VISSEFATION PM SIiTVET DATED 0640rb TD BE: / / : / PEED VON-ft) BY DClA E �SFME♦NT/1 SETBACK 4 CURVE RADIUS CHORD LENGTH CHORD BEARING C1 1314.51' 9,57' N 88'54'52" E C2 1314.51' 80.36' N 86'57'16" E C3 1344.51' 87.74' N 86'20'10" E C4 1363.21' 86.48' N 85'51'42" E LINE BEARING DISTANCE L1 S 86'10'36" E 8.58' L2 S 85'18'51" E 53.90 L3 S 87'18'59" E 41.31' L4 S 34'50'06" E 34.53' L5 S 34'50'06" E 20.60' L6 S 78'07'12 W 54.9C L7 N 36'41'18" W 21.88' L8 N 36'41'18 W 36.78' L9 N 36'41'18" W 17.82' L10 N 89'08'31" E 20.00 L11 S 00'51'29" W 14.41' ff /F +`l/r _.\+ ///i \l+' !♦ JJ�rl.a!! \I`�\i\ !�/r/iTi•r r!°!'�I l � � � \�(( - / _.--! ql ll �.� \. .Ot\7\11�\1\L// Ili j /�/ J \ ♦ 1 I i I ., i /'r i \e\ a _ �..I+ C^I'/`ljlai%•L'// 'l { t'' DONNA W WF GINNER //, OB 9687, PG Ovu N �i /% �.\�\I� PB B4, PG 61 LOCATION MAP roaule Y r l%/ . nvim•.. _ 1 ; !\ t l�f'` /T . ry r\�_ r y � / i 'j v�i / . \ P� arr MOD /,12D' OCJ'AN eRO06E v ° / / / �+•Y / / / / ADV190R5, LAC U IfS 6 CbNBMICE OCEAN QeV'DHE / f% ZIBACK/Ja y. \y fy y j+7-/J mot/ DB8600 PG 03% BACK /// j \ l I • - J 1 / / J! n - - PB w, PG 81 FT.00D ZCINe LINE ••w . � •,•+ .• / -"T �_ \,� :/�/1�/! ._ al ' w I/ //, \'11'!�� _ N/ 17d :f_ - PROPERTY BOUNDARY 9 •�4'��/ 1:'- { \1 ,,/ �•I •;// rROOD ZONE VE�221 F __-_--_-_ -�' E/.5®.81i 3� I f I \ - / L. X •'/'�[ I f / PORT CT' ye i,' '•�~I t �1t}y 111 / / /, r / 1 y� j" T ADVISORS, LLC APJ{N WI"}.H WATER LINE --------- / IA- /r 111 �lJ \ \ 1 / if ? / - > 1 I \ DB 348�q/ PG 0276 Y i ' ' /' IIII ,yi "1 ul! / l/' • /a 1 /'/ / /- 1 /l ri, PB M, PG III/ 50B YA®SE19Aac -•- - - - - 7, 'dial //\.N � % l � �• ;1 L EXISTING; . \ \ � lli' ` ' I// �48e.DO' / V EXISTCONTCLRS - - - 12 _.._ N/F �\ PROPOSED CxaNFOtm; - y 1 A, / jl !/r 6�I?� PINE", L�LCP Q HST LIE OP J -u - TH iI!/!// \: t `1 N i. i If( / / l.J : 488.83• 08 21Q PG 216 v /,� WaMAT10N !/11 l\t C hcc. l,/, 1Mf. I PS 6d, PG 81 Na /ll /. i Jf /, ._� / 1 \ 11 .. / / w CAMA SETBACK -® - 7,, /. 1 ! / �. / r / n FAST If•E ff KGETAIILYV f / LOCATED AND APPROVED N/F H1MN6 PAD C0MP/2C8 PORT c LL /_�.. A 1 C TE, \ ! \ . i/ 60' CIQ'lW EROOBLE OB 3000, PG 03" SETBACK.-.. - - - - PIS 64, PG e1 , r!/ 1 1 am 20 IS. / PORTCRY / ADVISORS, LS dli/ ♦ i\. ..�!I //J <\ L w--I ry PBPG DI -sG_•-- 1. �/ >\•�:;-' firms. ARWNING PROPERTY OW ENS LOT 3 - PONT CTY ADMSORS. LLC P.0 BOX 1967 WAIJINGTOfN. NC 28402 D.8. WOO. M. 035B LOT 5 - PORT CITY ADVISORS. LLC P.0 BOX 1967 WILMINGTON. NC 28402 D.B. MOD, PG. 03M REFERENCE IS MADE TO THE EQIOWINC' 1. ALL STREETS SHOWN ARE PRIVATE UNLESS OTHERWISE NOTED. 2 REFEPFNCE SURVEY CAPE FEAR ENGINEERING. MC DATED .INN 8, 2015. 3. AREA BY CODRDINAIE METHOD. 4. ALL DISTANCES ARE GROUND HORIZONTAL UNLESS OTHERWSE MOM. 5. 9 EDE �ZONESOM HEREON LES IN TFEMA, FLOOD INSURANCE R E MAP. 2CO M ON THE WWRMIITY PANEL NUMBER 372010540OJ, DATED JUK Z 2006. 6. THERE ARE NO MSIBLE ENCROACHMENTS ON THIS PARCEL 7. PROPOSED USE OF THIS LAND IS RESIDENTIAL e THIS PROPERTY IS ZONED lE-1. % ELEVATIONS BASED ON NAVD B8. 10. TOTAL DISTURBED AREA IS 0.31 ACRES. I. SURVEY OF FIRST UK W STABLE VEGETATION SURVEYED BY CAPE FEAR ENGINEERING AS NOTED. 12. TOTAL SITE AREA - 1.37 ACRES. 11 PILING SZE IS 8' X 8'; PRlNGS DEPTH SHOULD BE A MINIMUM OF 16' OR 20 TIMES THE ANNUAL LONG TERM AVERAGE OCEAN EROSION RATE OR PER STRUCTURAL ENGINEER SPEGFICATONs. 15. THE MAXIMUM WA IS 6,207 PER NCOENR STORMWATER PERMIT NO. SWB 031025. NO IMPERVIOUS AREA PROPOSED AT THIS T ME. 16. FRONT YARD SETBACK: "A FEET FROM THE PROPERTY UN; OCEAN FRONT YARD: NOT LESS THAN 25 FEET FROM THE ESTABU191FD CANA UK. 17. REAR YARD SETBACK: 251E OF THE MEAN LOT DEPTH; PROVIDED THAT THE REAR YARD NOT EXCEED 25 FEET, 18. DENSITY: A MAXIMUM OF ONE DETACHED SNGUE-FAMILY RESIDENTIAL DWELLING PER ACRE. IS. TAX PARCEL 10 FOR LOT 4 IS 256M190C4 OSTNNm FROM W.S. 20. MINIMUM SEPARATION BETMEEN DETACHED SINGLE FAMILY RESDENTIAL DWEUINGS SMALL BE 20% 21. WASTEWATER SYSTEM: 5' F STRUCTURE PER BRUNSWICK COUNTY HEALTH DEPARTMENT. 22. THE PROPOSED BUILDING PAD 1S AT 1250. 23. EXISTING TOPO MTNN PROPOSED UNITS OF DISIURBANCE FROM FIELD SURVEY BY CAPE FEAR ENGINEERING. INC, ON DECEMBER 21. 2015. 4 BO 8. PG 61 4Q' 4 40• IO 2Y X 34' SHEET I INCH -4W 4p q 40• 6C SSUED FOR REOULATM RENEW A B6UW PoRPEGUTATORY REVEW E]N 122N6 DESCRIPTION DATE PENSIONS -1 - 11" X 17• SHEET I NCH -SY aW1W4:I1N/ LA40 ��2 �3 ZH $.' ° • "ems '�0 4?I/YI.MµM1�p CAPE FEAR ENGINEERING fs1 PooRNrm-sis 1DlxermA Nc 2eAsf TEL ryfq Y9-10µ FAXN9f01 a67-fas WWW9.011 WGLK19aE.Gl6't1 ppaSer Ira-ATo4 MAW1 YNB AS NIIFO i _-EIVED DATE, A 0R Alb TMO°0i� [`C,Vj VVlUViINGTON, NC PALM COVE JAN 1 429016 TCA NOR a� L�FRLAN 673Z304 L Crl Locality Ocean Hazard Estuarine Shoreline " ORW Shoreline (For official use only) GENERAL INFORMATION LAND OWNER Name Long Leaf Pine, LLC Address P.O Box1967 Permit Number S'6 IKI `O#" Public Trust Shoreline Other City Wilmington State NC Zip 28402 Phone NIA Finaii NIA AUTHORIZED AGENT Name Cape Fear Engineering, Inc. Address 151 Poole Rd, Suite 100 City Belville State NC zip 28451 Phone (910) 383-1044 Email-elizabeth.nelson@capefearengineering.com LOCATION OF PROJECT: (Address, street name and/or directions to site. If not oceanfront, what is the name of the adjacent waterbody.)1836 East Main Street, Sunset Beach, NC, Lot #4 Palm Cove, Jink's Creek DESCRIPTION OF PROJECT: (List all proposed construction and land disturbance.) Single Family ResWence, Fill and grade only SIZE OF LOT/PARCEL: 59,791 square feet 1.37 acres PROPOSED USE: Residential Q (Single-family Q Multi -family Q ) Commercial/Industrial ❑ Other ❑ COMPLETE EITHER (1) OR (2) BELOW (Contact your Local Permit Officer ifyou are not sure which AEC applies to your property): (1) OCEAN HAZARD AECs: TOTAL FLOOR AREA OF PROPOSED STRUCTURE: NIA 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: N/A 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= If yes, list the total built upon area/impervious surface allowed for your lot or parcel: 6,207 (all lots) square feet. RECEIVED DCM WILMINGTON, NC 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 Long Leaf Pine, LLC see Deed Book 2142 page 0216 in the Brunswick County Registry of Deeds. nan owner by virtue of inheritance. Applicant is an heir to the estate of probate was in County. =f 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) (1) Port City Advisors, LLC 503 Olde Waterford Way, Suite 200, Leland, NC 28451 (2) (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 23 day of December 20 15 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. JAN 1 2 2016