HomeMy WebLinkAboutSB_16-06_ConnerTown of Sunset Beach SB 16.06
Local Government Permit Number
CAMA
MINOR DEVELOPMENT
PERMIT
as authorized by the State of North Carolina, Department of Envlronment,
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 Donna Conner, authorizing development in the Ocean Hazard (AEC) at 1842 East Main Street (Palm Cove Lot
#7), in the Town of Sunset Beach, as requested in the permittee's application, dated December 23ro, 2015, This permit,
issued on January 191h. 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: Grade and fill
(1) All proposed development and associated construction must be done in accordance with the permitted work plat
drawings(s) dated received on December 319, 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. — -- -- -
-JC:ul WiLYINGTON, NC
(Additional Permit Conditions on Page 2)
JAN 1 5 26116
This permit action may be appealed by the permiftee or other qualified persons
wilhin twenty (20) days of the issuing date. 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:
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 Wihout the wnllen approval of the Division or Coastal
Management.
Richard Hathcock
CAMA LOCAL PERMIT OFFICIAL
700 Sunset Blvd. N.
Sunset Beach, NC 28468
PERMITTEE
(Signatu wired if conditions above apply to permit)
Name: Conner
Minor Permit # SB 16.06
Date: January 191h, 2016
Page 1
)une disturbances will be allowed only to the extent necessary for development and if the dune's
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.
(6) 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: a4CZ�-J jj,:dL " _'— DATE: -���—
PERMITTEE
AEC HAZARD NOTICE
Project Is In An: —Ocean Erodible Area x High Hazard Flood Area —Inlet Hazard Area
Property Owner. Donna W. Conner
Propar ty sddraas: Lcit #7, Pakr rom Subdivision, 1842 East Main Street, Sunset [Beach, NC 28468
Rztt Loy Was ?lad,:d: _ November2004
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 stomps, erosion
and currents. The rules of the Coastal Resources Commission
require thatyou receive anA1 C 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 gmriag permits, the
Coastal Resources Cormnission does not guarantee the safety of
the development and assumes no liability for future damage to
the developn^aart Permits issued in the Ocear. Fazard Area of
Eavimnmental Concern include the condition that structures be
relocated or dismantled ifthey become imminently tbrcatcncd by
changes in shoreline canfiguraeon. 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 anmal long-term
average ocean erosion rate for the area where your property is
locatedr9 2 feet per year -
The rate was established by careful analysis ofaerial 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
'8 feet deep in this area.
Preferred ocesufrootprotection measures are beach nourishment
and relocation of threatened structures. Hard erosion control
stucttres such as bulkheads, seawalls, revetments, groins, jetties
and breakwaters are prohibited. Temporary sand bags may be
authorized under certain conditions.
The applicant mustacknowledge this infbrmationand requirements
by signing this notice in the space below. Without the proper
signature, the application will not be complete.
Applicant SrgriWure Date
L'd £LZZ-49L-£0L
SIRMA KOTETLishazard notice isrequired for development
in areas subject to sudden and messivestotms 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 beinre woric begins on the project site, the Local Permit
Officer must be contacted to determine the vegetation fine and
setback distance at yoursite. Ifthe property has seen little change
since the tine of permitissuance, 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 rcmcamred. Also, the occurrence ofa major
shoreline change as the result ofa storm within the 60-dayperiod
will necessitate temeasaremcnt of the setback It is important
that you check with the LPG before the permitespires for officra1
approval to continue the work after the permit has expired_
Generally, iffoundationpilinge have been placed and substzntiat
progress is continuing, permit renewal can be authorized. It is
unlawfid to continue work afterpemdr expiration.
Far mare infarrrafipn, eonurcr
F7chard Hathhoock
Local Permit Officer
700 Sunset Boulevard
Address
Sunset Beach, NC 20468
Locality
(910) 579.0068
Phone Number
RECEIVED
DCM WILMINOW60MI7
JAN 1 2 2016
19uu00 euuo4 dgZ:£0 9 L £Z 09(1
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
hereby certify that I own property adjacent to Donna W. Conner s
(Name of Property Owner)
property located at 1842 East Main Street, Lot 7, Palm Cove
(Address, Lot, Block, Road, etc.)
on Sinks Creek in Sunset Beach . N.C.
(Waterbody)
(Cityrrown 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)
Si tur•e
D W. Conner
Print or Type Name
13279 Catharpin Valley Drive
Mailing Address
Gainesville, VA
Q49'StatelZip
(703)407-9988
Telephone Number/email address
12/21/15
Date
'Valid for one calendar year after signature*
(Adjacent Property O ner Information)
r
Signature*
Port City Advisors, LLC
Print or Type Name
P.O Box 1967
Mailing Address
Wilmington, NC 28402
City/State/Zip
(910) 540 -9716
Telephone Number/email address
12/21/15
Date*
(Revised Aug. 2014)
RECEIVED
DCM WILMINGTON, NO
JAN 1 3 2016
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to Ana W • Conner 's
(Name of Property Owner)
property located at 1842 East Main Street, Lot 7, Palm Cove
(Address, Lot, Block, Road, etc.)
on Tinks 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.
I have no objection to this proposal.
I have objections to this proposal.
d'�I"`t •�3.i� �"�� �`s1C,1[�iit(�sYJl�f tJti(sz�a� i["T71sR a ' .9.cfis`�(d�. -� t"'li]1a
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)
Suture
W. Conner
Print or Type Name
13279 Catharpin Valley Drive
Mailing Address
Gainesville, VA
colstate/Zip
(703)407-9988
Telephone Number/email address
12/21/15
Date
'Valid for one calendar year after signature'
Information)
Signature"
Finley Efard, LLC
Print or Type Name
2808 Chelsea Circle
Mailing Address
Durham, NC 27707
Cibustatemp
Telephone Number/email address /^�
12/21/15-�l..EWEE)
Dare* 11MINGTON, NG
(RevisedAug.201,# u 7016
�II�111/lck Cl�l''NIIAlater of Y,s Ppage I of +ram
Brenda M. Ct� Relater of tlaadf
a;-1a-2617 Ie:N:e5."a arw ih Cme,ty, me
W REVSNIS STRIP: St7aa.N (aa52582)
Presenter L- G---R-'t-yr-T--�
C' h 3 _ Finance
0PO;:mu6.11,: cw iry,zx ar'.ru:9'tos
"0?Fel Cyai9nd
Prepared by: MURCHISON, TAYLOR, & GIBSON, PLLC
16 North Fifth Avenue, Wilmington, NC 28401
WE PREPARED THE DEED IN THIS TRANSACTION BUT WE MADE NO EXAMINATION OF
TITLE AND WE EXPRESS NO OPINION ON TITLE TO THE PROPERTY.
This instrument was prepared by Joseph O. Taylor, Jr, a licensed North Carolina attorney. Delinquent
tares, if any, are to be paid by the closing attorney to the Brunswick County Tax Collector upon
disbursement of closing procaeds. The closing attorney is Lila & Godbey, P. C.
STATE OF NORTH CAROLINA Revenue Stamps $1.700.00
COUNTY OF BRUNSWICK Parcel Number 256MB007
THIS WARRANTY DEED is made this � day of September, 2015 by
and between LONG LEAF PINE, LLC, a North Carolina limited liability company with a mailing
address of 503 Olde Waterford Way, Suite 200, Leland, NC 28451 (herein called "Grantor"), and
DONNA W. CONNER, unmarried, with a mailing address of 13279 Catharpin Valley Drive,
Gainesville, VA, 20155 (herein called "Grantee"):
WITNESSETH:
THE GRANTOR, for and in consideration of the sum of Ten Dollars ($10.00) and
other valuable considerations to it in hand paid by the Grantee, the receipt whereof is hereby
acknowledged, has bargained and sold, and by these presents does hereby grant, bargain, sell, and
convey unto Grantee, her successors and assigns forever, all that certain real property located in
Brunswick County, North Carolina, and more particularly described in Exhibit A attached hereto
and incorporated herein by reference.
SUBJECT TO (i) all easements, encumbrances, rights -of -way, restrictive
covenants, and other matters of record; (ii) ad valorem taxes for current and all subsequent years;
00133316
RECEIVED
DCM WILMINGTON, NC
JAN 1 22016
As fa
MW
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor Donald R. van der Vaart
Secretary
AGENT AUTHORIZATION FORM
Name of'r,> wig .:rssr Applying for Permit: Name of;';s 1c-iag ,:Y for this project:
Donna W. Conner E►imbeth Nelson, Cape Fear Emoneering
Owner's Mail r g Address: Agent's Maigng Address:
13293C.attae�24-rL latferD;la- Ca^^revrL�'gcez:-Nng
Gainesville- VA 20155 151 Poole R(L Suite t00 _
$efige. N(7 74a'451 '
Email: Email: eliaabette_.;elsonae2psfe2r=n�neerin coui
Phone Phone L910] 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 W fc-,G1mIi o: con,irtict Eft& ferlBrWIing (acgVily);
S6nc1e It-Dit r c= d,7ncc fOr ;_se grado an'.v
Trojec4' Siga Aj rcr &—: Lo: )Pah-A ate 5:x4= NvisNecu 1842 E Main S47ae
Suave e(mch
Property fiwrrter SiDnafirns p;�•
*This certification is vard 9 year from date signed by property owner.
N.C. Division of Coastal Nanagemeryl
127 Cardinal Drive Ext., WllffWVlon, NC 29405
Phone: 910-796-i215iFAX. 910395-3%4 Internet: wxw.nc oaslalmanagarnentnel
M E9w Op?r * l aHma" lclon 610"ei
RECEIVED
DCM WILMINGTON, NC
JAN 1 2 2016
0LZZ-49L-£0L ;9uuo0euu0a dLZ:£09L£Z0a0
CAPE FEAR
ENGINEERING
151 Poole Road, Suite 100
BehAlle, NC 28451
TEL (910) 383-1044
FAX (910) 383-1045
w .capefearengineering.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 1
Palm Cove Subdivision, Lot 7
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 ti
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 6 & Lot 8 property owner
1
Copy
Property Deed
REMARKS ' Permit for Fill and Grade Only
CC: Ca a Fear Engineering, Inc.
File 675-0307- "38"
Signed:
Elizabeth Nelson, E—
Received By:
Date:
P:675575om71ADMIwcnmv,Miro a 15FMWacram'2015-12-23sar,�m d. DCM WILMINGTON, NC
JAN 1 2 2016
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CURVE
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1314.51-
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S 76-57.40" W
C2
23.00'
35.51'
N 26-02'48" E
LINE
BEARING
DISTANCE
L1
N
89'14'17" W
43.09'
L2
S
84.28'52" W
52.00'
L3
N
2721'51"
W-
13.62'
L4
S
2T21'51"
E
- 49.73'
LS
S
27.2V51"
E
12.55'
L6
N
27.2V51"
W
30.91'
L7
S
2721'51"
E
18.55'
L8
S
30'14'23"
E
5.00'
L9
S
30'14'23"
E
64.81'
L10
S
3914'23"
E
12.09'
L11
N
64'55'18"
E
8.35'
L12
S
25'04'42"
E
10.71'
L13
N
7635'05"
E
35.68'
L14
W
76-35'05"
E
57.44'
L15
S
18'02'56"
E
12.77'
L16
N
59-45.37"
E
20.20'
L17
N
59-45'37
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15.12'
L18
S
76-35.05"
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38.35'
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ADJOINING PROPERTY OWNERS:
LOT 6 - BRUNSWICK LAND HOLDINGS, LLC
503 OLDE WATERFORD WAY. SUITE 200
(ELAND. NC 2M51
D.B. 2142. PG. 214 MC 84, PG. 81
LOT 8 - MILEY WARD. LLC Q 4I
2808 GNELSEA CIRCLE
DURHAM, NC 27707
D.B. 3678. PG. 083p 22' X 34' SHEET 1 INCH .4d
.a p 40• 3v
REFERENCE IS MADF TO THE FOLI.OWMG:
1. ALL. STREETS SHOWN ARE PRIVATE UNLESS OMMIMSE NOTED. 11' X 17' SHEET 1 INCH -W
2. REFERENCE SURVEY CAPE FEAR ENGNEERNG, INC. DAZED IAN 00.
MIS.
3. AREA BY DOMINATE METHOD.
4. ALL DISTANCES ARE GROUND HORIZONTAL UNLESS OTHERWISE NOTED.
5. THE PROPERTY SHOWN HEREON LIES IN ZONES YE 18. M. 22 AS
SHOWN ON THE FEMA. FLOOD INSURANCE RATE MAP, COMMUNITY
PANEL NUMBER 372010540D1. DATED JUKE 2. 2006.
6. MERE ARE NO WSIBLE ENCROACHMENTS ON MIS PARCEL
7. PROPOSED USE OF THIS LAND IS RESIDENTIAL.
8. MIS PROPERTY IS ZONED CR-1.
9. ELEVATIONS BASED ON MAYO BB
10. TOTAL DISIURBED AREA IS 0.29 AMES.
it. SURviY OF FIRST UNE OF STABLE VEGETATION SURVEYED BY CAPE
FEAR ENGINEERING AS NOTED.
12. TOTAL STE AREA = 1.18 ACRES
13. PILING SIZE IS B' X 8` PILINGS DEPTH SHOULD BE A MINIMUM OF 18'
OR 20 TIMES ME MNUN. LONG TERM AVERAGE OCEAN EROSION RATE
OR PER STRUCTURAL ENGINEER SPECIFICATIONS
15. ME MAXIMUM WA IS 6,207 PER NCDENR STORMWATER PERMIT Na
SWB 051025. NO IMPERWOUS AREA PROPOSED AT TARS TIME.
16. FRONT YARD SETBACK: 50 FEET ROM THE PROPERTY UNE: OCEAN
FRONT YARD: NOT LESS MAN 25 FEET FROM ➢ E ESTABLISHED CAMA
UNE.
17. REM YARD SETBACK: 25% OF ME MEAN LOT DEPTH: PROWDED MAT
ME REM YARD NOT EXCEED 25 FEET.
18. DENSITY: A MAXIMUM OF ONE DETACHED SINGLE-FAMILY RESIDENTIAL -
DWELLING PER ACRE.
19. TAX PARCEL ID FOR LOT 7 IS 256M8007 OBTAINED FROM CJ.S
20. MINIMUM SEPARATION BETWEEN DETACHED SINGLE FAMILY RESIDENTIAL
DWELLINGS SMALL BE 2W.
21, WASTEWATER SYSTEM: 5' FROM STRUCTURE PER BRUNSWCK COUNTY
REALM DEPARTMENT.
22. THE PROPOSED BUILDING PAD 15 AT /ZW.
23 EXISTING TOPO WIMIN PROPOSED UNITS OF DISTURBANCE FROM FIELD i V `D
SURVEY BY CAPE FEAR MONEERING, INC. ON DECEMBER 21, MIS,
; V1 UV!LMINGTON, NC
JAN 1 3 2016
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PALM COVE
SUNSET BEAC14
NORTH CiAROLNA
LOT 7
GRADING PLAN
NRN. e ,a...a
673Z 07 G i
Locality
Ocean Hazard —4Estuarine Shoreline ORW Shoreline _
(For official use only)
GENERAL INFORMATION
LAND OWNER
Name Donna W. Conner
Address 13279 Catharpin Valley Drive
Permit Number JL d�
Public Trust Shoreline Other
City Gainesville State VA Zip 20155 Phone NIA
F.mail N/A
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@capefearengineedng.com
LOCATION OF PROJECT: (Address, street name and/or directions to site. If not oceanfront, what is the name of the
adjacent waterbody.)1842 East Main Street, Sunset Beach, NC, Lot #7 Palm Cove, Jink's Creek
DESCRIPTION OF PROJECT: (List all proposed construction and land disturbance.) su+9le Famiy Residence, Fill and grade ony
SIZE OF LOT/PARCEL: 51, 548 squarefeet 1.18 acres
PROPOSED USE: Residential 0 (Single-family Q Multi -family Q ) Commercial/Industrial Other
COMPLETE EITHER (1) OR (2) BELOW (Contactyour Local Permit Officer ifyou are not sure which AEC applies
to your property):
(1) OCEAN HAZARD AECs: TOTAL FLOOR AREA OF PROPOSED STRUCTURE: N/A 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 Pemut issued by the NC Division of Water Quality?
YES= NC=
If yes, list the total built upon areatimpervious surface allowed for your lot or parcel: 6,207 (all lots) square feet.
_iVED
,iNGTON, 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)
✓Man owner or record title, Title is vested in Donna W. Conner
page 0691 in the Brunswick County Registry of Deeds.
Man owner by virtue of inheritance. Applicant is an heir to the estate of
probate was in County.
see Deed Book 3687
Mf 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)
Finley Efard, LLC
(2) Port City Advisors, LLC
(3)
(4)
(Address)
2808 Chelsea Circle, Durham, NC 27707
503 Olde Waterfor Way, Suite 200 Leland, NC 28451
ACKNOWLEDGEMENTS:
1, 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 par icu-
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
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
anypermit. Anyperson developing in an AEC withoutpermit is subject to civil, criminal and administrative action. J
uGTON,NG
JAN 1 2 2016
JAN 1 2 2016