HB_03-078_Sparks Builders

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Local Government Permit Number
CAMA
MINOR DEVELOPMENT
PERMIT
as authorized by the State of North Carolina, Department of Environment
and Natural Resources and the Coastal Resources Commission for development
in an area of environmental concern pursuant to Section 113A-11 B of the
General Statutes, "Coastal Area I_vlangge arl.
Issued to S 11�authorizing devel/o�pment' �tI Tri 7e�...
at �1 Vick- Ve l 'r
as requested in the permittee's application, dated 1
This permit, issued on 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.
PERMIT TO CONSTRUCT A SINGLE FAMILY RESIDENCE, INSTALL SEPTIC
SYSTEM, GRAVEL DRIVEWAYS, AND RETENTION AREAS ALL OF WHICH
WILL BE LOCATED OUT OF THE 60 FOOT SETBACK AREAM
All proposed development and associated construction must be done in accordance with the
permitted work plat drawing(s).
1. No dune disturbance of a dunes area will be allowed for this development because the dune's
protective value would be weakened or reduced.
2. All construction must conform to the International Building Code requirements and all other
local, State and Federal regulations and the local flood damage prevention ordinance as
required by the National Flood Insurance Program.
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. Pursuant to 15 NCAC, Subchapter 7J. 0406 (b), this permit may not be transferred, or
otherwise disposed of to a third party, except by the Division Director.
5. The structure must be set back 60 feet from the first line of stable natrual vegetation
(FLSNV). The permittee is required to contact the Local f,crtorQy`bofe he
plans to begin construction to strange a setback measurem y,", ch will be effective for
sixty(60) days barring a major shoreline change. Constructi n'must begin within sixty (60)
days of the determination or the measurement is void and must be redone.
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 per-
mit m,.st 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 modifications not covered
under this permit requires further written permit approval.
All work must cease when this permit expires on December
31, c9m(n -
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.
CUASIAL i ' AGF-T
�IMEMD
Local Permit Ofiicer (s gnature)
L�(ilY� CTt ',?eo,—C
nam
address
a$ gcpa
(signature required if special conditions above apply to permit)

Local Government
CAMA
MINOR DEVELOPMENT
PERMIT
as authorized by the State of North Carolina, Department of Environment
and Natural Resources and the Coastal Resources Commission for development
in an area of environmental concern pursuant to Section 113A-118 of the
General Statutes, "Coastal Area 1_v1anagergent."
Issv.9d to
o t?2
Permit Number
II �11 as requested in the permittee's application, dated I H r~U :5
This permit, issued on 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.
6. Any structure shall be relocated or dismantled when it becomes imminently threatened
by changes in shoreline configuration. The structure(s) shall be relocated or dismantled
within 2 years of the time when it becomes imminently threatened, and in any case upon
its collapse or subsidence.
7. The septic system shall be installed in accordance with Brunswick County Health Department
#03-61763. r
8. No impermeable surface shall be allowed over any functional part of the septic system.
Septic system must be installed according to Brunswick County Health Department. All
pilings must be located at least 5 feet from any portions of the septic system. Waterline must
be located at least 10 feet from all portions of the septic system. All retention areas shall a
minimum of 25 feet seperation from all portions of the septic system..
9. In accordance with T15A NCAC 7H. 0308(a), no seawall or riprap revetments will be
allowed in the future should any structure become threatened from erosion.
9. All construction shall meet all requirements of chapter.157.060 and Chapter 158.00 located
in the Town of Holden Beach Code of Ordinances and any other sections that apply to the
construction of the single family residence. _ T
10. The structure must be elevated on pilings with a diameter of at 8 inches and the first
floor level of the sills and joists must meet the 100-year flood elevation level of 17feet.
11. The concrete slab elevation has been approved at an elevation of 7.0 above mean sea level.
The concrete slab elevation shall be provided on the final survevll 1`a
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 per-
mit m,.st cease until the appeal is resolved.
This permit must be on the project she and accessible to the
permit officer when the project is inspected for compliance.
Any maintenance work or project modifications not covered
under this permit requires further written permit approval.
All work must cease when this permit expires on December
31, c�)M (n
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.
ILocal Permit Officer (ssIgrnnature)
name
address
(signature required if special conditions above apply to permit)

4`
•-6�r 'ter o�ci��1 ��
Local Government
LAMA
MINOR DEVELOPMENT
PERMIT
as authorized by the State of North Carolina, Department of Environment
and Natural Resources and the Coastal Resources Commission for development
in an area of environmental concern pursuant to Section 113A-118 of the
General Statutes, *Coastal Area. wlanage ent."
Issued to -�� !� A 11� Vl I I 1 S authorizing development %�
U MCI l oyp-- xI
b 172
Permit Number
as requested in the permittee's application, dated
This permit, issued on 1a--3-03 is subject to compliance with the application and site drawing (where consistent
with the permit), all applicable regulations and special conditions and notes setforth 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.
12. The highest point of the structure per the Town of Holden Beach Code of Ordinances
definition shall be no higher than 45 feet above mean sea level.
13. The pilings shall be installed at least eight feet below undisturbed soil.
14. The innovative stormwater system authorized with this permit must be maintained for the
life of the structure addressed.
15. Section 158.09 (C)(4) states in part that it is the intent of these regulations that
stormwater flow be contained within property lines in question, and not be directed onto
adjacent real estate.
16. All areas below base flood shall be installed with all treated material and shall be designed in
accordance with FEMA's break a way wall design. Before a final inspection is to ne on
the structure a V - zone certificate shall be submitted to the -Towns inspections departm t that
has been completed by a state licensed Engineer. ,y »'{ :_
CGS r1 4 2003
nwls1O.` "Or GMENT
This permit action may be appealed by the permhtee or other
qualified persons within twenty (20) days of the issuing date.
From the date of an appeal, any work conducted under this per-
mit m st 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 modifications not covered
under this permit requires further written permit approval.
All work must cease when this permit expires on December
31, (79Mj() "
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.
CUHZ) 11 --
i r9 mnl r. \
Local Permit Officer (slgnature)
name
>^,� address
1'I, Permittee
(signature required if special conditions above apply to permit)

Project Is In An
Date Lot Was Platted:
(.09ulra �CVQ �)r t \/e1 �Caen
AEC HAZARD NOTICE
Ocean Erodible Area high Hazard Flood Area Inlet Hazard Area
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 alteration 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.
The best available information, as accepted by the Coastal
Resources Commission, indicates that the annual ocean
erosion rate for the area where your property is located is
feet per year.
The rate was established by careful analysis of aerial
photographs of the coastline taken over the past 50 years.
Studies alcn indicate that the shoreline could move as
much as eet landwarri ;n a mn;nr can'
Th oodwatersinamajorstormarepredictedtobeabout
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 devices, including sand bags, may
be allowed under certain conditions.
This structure shall be relocated or dismantled within two
years of becoming imminently threatened.
The applicant must acknowledge this information and
requirements by signing this notice in the below space.
Without the proper signature, the application will not be
complete.
Applicant's Signature
1 Q -1- d3
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 will
determine the vegetation line and setback distance at your
site. If theproperty has seen little change and the proposed
development can still meet the setback requirement, the
LPO will inform you that you may begin work. It is impor-
tant that you check with the LPO before the permit expires
for official approvall to continue the work after the permit
has expired. Generally, if foundation pilings have been
placed and substantial progress is continuing, permit
renewal may not be necessary. If substantial progress has
not been made, the perni�t must be renewed and a new
setback line established. It is unlawful to continue work
after permit expiration without this approval.
For more information, contact:
PLA"& /l�r � 1 z_J�/�
Loca ermit Officer
Address
•
/♦
Pharne
!S�031q,&
p,, 0 4 2003
0IVIS1ON a - MENT
COASTAL MAN
Revised 11193

BEFORE YOU BUILD
Setting Back for Safety: A Guide to Wise Development Along the oceanfront
When you build along the oceanfront you take a calculated
risk. Natural forces of water and wind collide with tons of
force, even on calm days.
Man-made structures cannot be guaranteed to survive the
force of a hurricane. Long-term erosion (or barrier island
migration) may take from two to ten feet of the beach each
year and, sooner or later, will threaten oceanfront struc-
tures. These are the facts of life for oceanfront property
owners.
The Coastal Resources Commission (CRC) has adopted
rules for building along the oceanfront. The rules are in-
tended to avoid an unreasonable risk to life and property
and to limit public and private losses from storms and
long-term erosion. These rules lessen but do not eliminate
the element of risk in oceanfront development.
As you consider building along the oceanfront, the CRC
wants you to understand the rules and the risks. With this
knowledge you can make a more informed decision about
where and how to build in the coastal area.
The Rules
When you build along the oceanfront, coastal manage-
ment rules require that the structure be sited to fit safely
into the beach environment.
Structures along the oceanfront must be behind the frontal
dune, landward of the crest of the primary dune and set
back from the first line of natural stable vegetation a dis-
tance equal to 30 times the annual erosion rate (a minimum
of 60 feet). Large structures (multi -family residential struc-
tures greater than 5,000 square feet and non-residential
structures greater than 5,000 square feet) must be set back
from the first line of natural stable vegetation a distance
equal to 60 times the annual erosion rate or 120 feet,
l SETBACK I SETBACK I�FIRST LINE OF
fy�II/JL- STABLE
ffTT II --II ,60, AVERAGE ANNUAL 30
AVERAGE ANNUAL
VEGETATION
L0LI NATURAL
(EROSION I EROSION
IRATE I RATE
ono I I tNJ
(
SMALL
STRUCTURES) I ST RUCTU RESI
PERMITTED
STRUCTURE;
ADEQUATE
SETBACK
whichever is greater. If the erosion rate is greater than 3.5
feet/year, the setback is 30 times the erosion rate plus 105
feet.
The Reasons
The beachfront is an ever -changing landform. The beach
and the dunes are natural "shock absorbers", taking the
beatings of the winds and waves and protectin the inland
areas. By setting back 30 or 60 times the annual long-term
erosion rate; you have a good chance of enjoying the full
life of the structure. At first, it seems very inviting to build
your dream house as close to the beach as possible, but in
five years you could find the dream has become a
nightmare as high tides and storm tides threaten your
investment.
The Exception
The Coastal Resources Commission recognized that these
rules, initially passed in June of 1979, might prove a
hardship for some property owners. Therefore, they estab-
lished an exception for lots which cannot meet the setback
requirement. The exception allows buildings in front of the
setback line if the following conditions apply:
(1) the lot must have been platted as of June 1,1979, and
not capable of being enlargedby combining with adjoining
'land under the same ownership, (2) development must be
as far back on the property as possible and in no case less
than 60 feet landward of the vegetation line, (3) no
development can take place on the frontal dune (4) special
construction standards on piling depth and square footage
must be met and (5) all other LAMA, state and local
regulations must be met.
The exception is not available in the Inlet Hazard Area.
To determine eligibility for the exception, the Local Permit
Officer will make these measurements and observations:
required setback from vegetation line
exception setback (maximum feasible)
rear property line setback
max. allowable square footage on lowest floor
lot area as calculated from vegetation line
piling length needed to extend 4 feet below MSL
PRE -PERMIT STRUCTURE; INADEQUATE SETBACK
PRE -STORM BEACH PROFILE
� POST -STORM BEACH PROFILE
ONE YEAR AFTER STORM/BEACH REBUILDING
After the storm, the house on the dune will be gone. The other house has a much better chance of survival.

—� •1 / Permit Number
:alias' l oil211
mn Hazard _Estuarine Shoreline _ORW Shoreline _Public Trust Shorchrie_Other
(For official use only)
10
ENERAL INFORMATI ON 0
G�
,.ND OWNTER,
Lme
ldress
ity State / C'
fame
zip. yL Phone
.ddressv X
) `-' 6 � Phone / _ 0 7 �- 7/) /
Zi�ygjfl/
LOCATION OF PR
Ldjacent waterbody.)
OF
oceanfront, what is the
(List all proposed construehpon and W disturbance:)
SIZE OF LOTIPARCEL: ro X %/ s square fed 71d acres O
G
PROPOSED USE: RtsidentialX (Single-family
Multi -family _) Coiericalllndustrial Other
TOTAL ENCLOSED FLOOR AREA OF A B GIN THE OCEAN HAZARD AREA OF
.N�,iROn,ME���rONCERNN e p �r-fir �f, .square feet (includes all floors and roof covered decks)
SIZE OF(B�UILDINGFOOTPRII�'T4AND OTHERft tv AL
ORBUILT-UPON Square feet
COASTAL SHORELINE AREA OF ENVMONMENTAL CONCERN (AEC%: tm tic
(Calculations includes the area of the roof/drip line of all buildings, driveways, covered decks, concrete ar masonry p
etc, that are within the applicable AEC.)(Attach your calculations with the project drawing .)
Choose the AEC area that applies to your property:-
(t)within 75 feet of Normal High Water for the Estuarine Resource Waters
Shoreline AEC
�dthin 575 feet ofNonnal High Water for the Estuarine Shoreline AFC, adjacent to Outstanding
(3)within 30 feet of the Public Trust Shoreline AEC
(Contact your Local Permit Officer if you are not sure which AEC applies to your property-)
STATE STOR.MWATER MANAGEMENT PERMIT: Is the project located' area subjrectt a State Stormwater
Management Pcrmit issued by the NC Divisio
YES NOJL�
If yes, list the total built upon area/itnpervio
eel. quare feet
NOV 1 7 2003
TOWN OF HOLDEN BEACH

To: 6ok"O>- ia' -
.7b98'��. )t:Q S w
k7e.2& 0�, 2-
III I .0 •0'd• •' :A•
This letter is to in(xs you that I have applied f'o/r a CAMA Pemsit on��the property
owned by.� �- at kl/? 911),L4 Lam) ✓�- fir'
Holder Beach NC. I have enclosed a copy of permit application and a copy of the
drawing of proposed project
If you have any comments on the proposed project, please M
�Y
Rhonda Phillips, Local CAMA Officer, Town of Holden Beach,110 Ro
Holden Beach, NC 29462 - Telephone -( 910) 842-6489. GO PS
Sincerely,
(Owner or
TELEPHONE NUMBER:
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O O Cued Fee
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Retum Reciept Fee
(Endosement Required)
O Restricted Da"Very Fee
O (Endorsement Required)
to
C3 Total Postage & Fees
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PS Form 3800, June 2002 See Reverse for Instructions

DATE: L 6
az -
To:
This letter is to inform you that I have applied for a CAAMA Permit on the property
owned by ( i4bi(S at / 3 (/l��itl�/IQ Ca✓� Dr
(sr a address)
Holder Beach, NC. I have enclosed a copy of permit application and a copy of the
.drawing of proposed project
If you have any comments on the proposed proj ect, please contact
Rhonda phillrp s, I.ocal CAMA Officer; Town of Holden Beach,110
OF
Holden Beach, NC 28462 -Telephone -[phone].
Sincerely, GOPgCP�
� ;� r
U.S. Postal Service..,
• • .
CERTIFIED MAILrM RECEIPT
TELEPHONE MM• I
(Domestic Mail Only; No Insurance Coverage Provided)
ion vlaR oar vrchalM a} www.uepa.com®
For delivery IMormetIr
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PS Form 3a0a. Jvne 20a2 See Reverse for Insiruclions

/aq� paw
DATE: /'/ . /S' 0
DEAR ADJACENT PROPERTY OW'U�'
This 1e is to inform you that I have applied for a CA -MA Permit Onn the prop W
AS �
owned by �,%�s JL( at d 1 I.ej W;01 (/U✓�
Holder Beach, NC. I have enclosed a copy of permit application and \ to
.drawing ofproposed project. O\ J�c0G
If you have any comments on the proposed project, please contact O P,s o -
Rhonda Phillips, Local CAMA Officer, Town of Holden Beach,110 RothschC'ild St.
Holden Beach, NC 29462 -Telephone [phone].
Sincerely,
(Owner or gent)
TELEPHONE NUMBER A Y 7
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RICHARD A. WINKLER, P.E.
239 OCEAN BLVD. EAST
HOLDEN BEACH, N.C. 28462
[phone]
SPARKS BUILDERS
1043 COQUINA COVE DRIVE
HOLDEN BEACH, N.C.
TOTAL LOT AREA
7,167 SF
TOTAL IMPERVIOUS AREA
HOUSE (INC O/H)................................... 1830 SF
• 1830 sq ft x 1.5 / 12 = 229 cu ft of stormwater containment
required.
• Utilize gutters and downspouts draining to an EEE ZEE LAY drain
system.
• Capacity of EEE ZEE LAY system = 3.75 cu. ft. / ft.
• Length of system required = 229 cu ft / 3.75 cu ft / ft = 61 ft.
• EEE ZEE LAY system must be located a minimum of 25' from r
septic system.
DEC 0 1 2003 I_
DIVISION OF
COASTAL NIANAGENMEN�
Drainage Bundle
Without Pipe
3'
EEE ZEE LAY DETAIL
nts
log3 art,
12" Drainage Bundle With
4" Dia Corrugated Perforated
P.E. Distribution Pipe
Drainage Bundle
Without Pipe
.aan,..
SEAL
5312 e
i =
c,
1/-(3 -0 3

RICHARD A. WINKLER, P.E.
239 OCEAN BLVD. EAST
HOLDEN BEACH, N.C. 28462
[phone]
SPARKS BUILDERS
1.(L43.- COOUINA COVE -DR
+ s.s
+ 7.,
r
s.s
+ 5.9
10.61
5.s
DRIVE I I DRIVE
6.5
--- ----- -----
COVERED PORCH !
PROPOSED HOUSE j
SLAB EL = 7.0' i a
OPEN DECK
I
I
1
1
I
1
I
I
I
;REENED
PORCH I I
+ 6.2
62.45
-ELEVATIONS FROM A SURVEY .BY
NORRIS & WARD SURVEYING
DATED 10-09-03
SCALE: 1' = 20'
+ 5.9
OF
pIVIS10NAGEMEri�
COASTAL MAN
SEAL
= i 53A2
ll-i3�O3

����Rrr.
D ''
�----
;.L,

GRAVEL
8" MIN
cover exposed gravel
bed with a geotech
fabric
adams blocks
min of 24"
from biofilter
and edge of
gravel pad allways
biofilter if possible
c V,
v >�
TYPICAL o Q S.T. 650 BIOFOLTER
GRAVITY FED SOSEPTIC TANK
approved
4" pVC pipe: Baer
water inlet
EARTH
TRENCH DEPTH AS STATED IN PERMIT
ADJUST TANK HIGHT TO MAINTAIN GRAVITY FLOW
MAINTAIN A 1% SLOPE MINIMAL
ed wood wall
fabric
support by
landscape
material

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v sSmV
dNdw 1,41sdoo
1N3W jo NpIs,NG
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SSHa aa►l� ,(W

ocalin• I paid d-9 LLWO P_ l Permit Number
)cean Hazard _Estuarine Shoreline ORW Shoreline _Public Trust Shoreline Other
(For official use only)
�ENERA.L InrFORMATION
,.AND OWNER _. DD MEHVE
game
4ddress
JAN 2 12004
DIVt�r
::itv _ Cy0hi 645 it State AIC, Zip Phone
AUTHOREEDGENT /
Name % /`7 6 ��__J ✓k
Address Pe &x
Ci � ���✓C S� StaV✓C Zi t�( / Phone
LOCATION OF PROJECT: (4863',s,s, strcet nawand/or directions to �Si If not oceanfront, what is the name of the
adjacentwateioody.)�—Pe/3 4LY/lUl✓YQ GD�� �� %7'
DESCRIPTION OF PROJECT: (List all proposed construction and 1 d disturbance.)
SIZE OF LOT/PARCEL: (P 2 X square feet 713 v acres
PROPOSED USE: Residential (Single-family Multi -family _) Conm=caVIndustrial _ Other
TOTAL ENCLOSED FLOOR AREA OF AJ� THE OCEAN HAZARD AREA OF
1vI ENI'MONENTAL CONCERN (AEC): n11" square feet (includes all floors and roof covered decks)
lvi( emf'lu /GP 1EN .
SIZE OF BUILDING FOOTPRINT AND OTHER IATERVIOUS OR BUILT-UPO!�'� S IN THE
COASTAL SHORELINE AREA OF ENVIRONMENTAL(AEC): CONCERN ( C): square feet
(Calculations includes the area of the roof/drip line of all buildings, driveways, cove-, ed decks, concrete or masonry patios,
etc. that are wife: n the applicable AEC.)(Attach your calculations with the project drawing.)
Choose the AEC area that applies to your property:.
(1)within 75 feet o Norrnal High Water for the Estuarine Shoreline AEC
�_ ,W n 575 feet of Normal Hieh Water for the Estuarine Shoreline AEC, adjacent to Outstanding Resource Waters
(3)within 30 feet of the Public Trost Shoreline ABC
(Contact yo:r Local Perrot Officer if you are not sure v.%nich AFC applies to your property_)
STATE STORM -WATER ARANAGEMENT PERMIT: Is the project located n area subject. a State StwmwateT
Manaeetnent Permit issued by the NC Dis =sio . i e�Qry YES NO
1_`yes, list the total built upon area/imperviou square feet.
��I;3 v
TOWN OF HOLDEN BEACH
z d 91662b8oi6 H3H39 N3Q1oH 3o NI'lol dtb:10 b0 1z Uer

ER i'ERM, ITS MAN HE REQUIRED: Tnc aamiN. you are pinning my require pemits other than the C.41vi 4 minor ocvclopmcni pzII=,..
sen•iec tvt have compiled a listing of the kinds or oerrrtits imt might be required. %vc suggest you check over the lis; � th your LpP , to
mine iraw orthese apply to your prgieot. Zoning. Drinking Water Well. Septic Tani: for other sani.an, wat;ie trcatmemsystemy. Bum in c: I
❑cal, Plumbine. Heating and Air Conditioning, insulation and Energy Conscn•mion. FIA Certification, Sand Dim.-. Scdtmeht Contra!, 74
i6sion Approval, Mobile Horne Park .4ppro�ml. Hiphwav, Connacrion, and others. I
� .,AN ? 12u04
%TEMENT OF OWNERSHIP: DN'
c undersigned, an applicant for a C.AMA minor development permit, being either th ovmC, jAkoperty iF AEC' or
arson authorized to act as an act for purposes of applying for a CAIJjA minor development permit, cer $A� j
;on listed zs landowner on this application has a significant interest in the real property described therein. This interest
be described as: (check one)
✓'/���
an o -er or record title, Title is v4s-tea in G1)L1�c see Deed Book
z in the B�JKiJ 1 C.� Co t Registry of Deeds. -
_an Ownerby virtue of inheritance. Applicant is an heir to the estate of
bat,- was in County.
i= other mt_-rest, such as written contra^t or lease, explain below or use a separate sheet and attach to this application,
1TMCATION OF ADJACENT PROPERTY uYiNERS:
'orfnernim certify flat fat following pcsons are owners of properties adi oining this property. I affirm that I have given
I'LAL NOTICE to eacb of them conce�tg my intent to develop this progeny and to apply for a CAMA.p t.
(N e-) (Address) A/C- PV2ler
/
/ h/
) ti (, � ,r RO
OR DEZ ELOPERS Its OCEAN HAZ.d.RD AND ESTIIAR`nPE HAZARD AREAS:
acknowledge tUat the land owner is aware that the proposed devclopm=t is planned for an area which may be
asceptiole to erosion andrar flood n& I aclaow'ledge that foe local permit officer has explained to me the particular
azard Drr obiems associated with tais lot This c planation was auompa_nied by recommendations concerning stabilization
nd tloodproofng techniques.
'ERMISSION TO ENTER ON LAND:
furthermore certify that I am authoriz.-d to g-ant and do in fact writ permission to the local permit o-:rcer and his agent
o enter on the aforementioned lands in eotmecriortwith evaluating information related to this permit application.
(ills application includes: general information (this form), a site drawing as described on fne bacl: of t`-s application, the
tvmership st:w.emcrit, the AEC r`.a: and notice where tlecessary, a check for 5100.00 made payable to the locality, and any
nformation as may be provided orally by the applicant. The details of the application as descnbed by these sources are
ncorporated withou, reference in any permit which may be issued. Demation . om these details will constirate a violation
)f any permit. Any person developing in an ABC without permit is subject tp civil, cri-ural and administrative action.
Tlis�ay°r ��Y 202L
for ptL-po5es n_::ilixig:s::CF:IvS�?u'u,:ap.71ica5or_-
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