NTB_16-17_Topsail Sunrise LLC

Issued by WiRO
North Topsail Beach
CAMA
MINOR DEVELOPMENT
PERMIT
as authorized by the State of North Carolina, Department of Environmental
Quality 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'
NT816.17 AMENDED
Permit Number
�r
Coastal Management
ENVIRONMENTAL OUALITV
Issued to Topsail Sunrise, LLC authorizing development in the Estuarine Shoreline Areas of Environmental Concern
(AECs) at 505 Tradewinds Drive., in North Topsail Beach, Onslow County as requested in the permittee's application
package, dated March 18, 2016, and received by DCM on April 22, 2016. This permit, issued on January 31, 2017, is
subject to compliance with the application and site drawings (where consistent with the permit), all applicable
regulations, 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: Construction of a residential dwelling with swimming pool and associated amenities and utilities.
(1) All proposed development and associated construction must be done in accordance with the permitted work plat
drawings(s) dated received by the Division of Coastal Management on April 22, 2016.
(2) All 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.
(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 [phone] for a final inspection at
completion of work.
(Additional Permit Conditions on Page 2)
This permit action may be appealed by the pernittee or other qualified persons
within 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
Jaso Dail
CAMA LOCAL PERMIT OFFICIAL
127 Cardinal Drive Extension
Wilmington, NC 28405-3845
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.
PERMITTEE

Name: Topsail Sunrise, LLC
Minor Permit # NTB 16.17 Amended
Date: January 31, 2017
Page 2
(5) All buildings/structures shall comply with the NC Building Code, including the Coastal and Flood Plain Construction
Standards of the N. C. Building Code, and the Local Flood Damage Prevention Ordinance as required by the
National Flood Insurance Program. 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.
(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 vegetated and stabilized (planted and
mulched) within 14 days of construction completion.
(7) The amount of impervious surface/coverage on this property shall not exceed 30% within 75 feet of the Normal High
Water line. Additionally, no development shall occur waterward of the Corp of Engineers Waterway Easement line.
(8) All buildings must be elevated on pilings with a diameter of at least 8 inches in diameter if round, or 8 inches to a
side if square; and the first floor level of the sills and joists must meet the 100-year flood level elevation.
(9) All pilings shall have a tip penetration greater than eight (8) feet below the lowest ground elevation under the
structure. The deck shall be constructed independently from the residence and shall be structurally detached.
(10) The permittee is required to contact the Local Permit Officer [phone], shortly before he plans to begin
construction to arrange a setback measurement that will be effective for sixty (60) days barring a major shoreline
change. Construction must begin within sixty (60) days of the determination or the measurement is void and must
be redone.
(11) Pursuant to 15A NCAC, Subchapter 7J.0406(b), this permit may not be assigned, transferred, sold or otherwise
disposed of to a third -party.
SIGNATURE: DATE:
PERMITTEE

Issued by WiRO
North Topsail Beach
CAMA
MINOR DEVELOPMENT
as authorized by the State of North Carolina, Department of Environmental
Quality 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"
NTB16.17
Permit Number
Issued to Topsail Sunrise, LLC authorizing development in the Estuarine Shoreline Areas of Environmental Concern
(AECs) at 505 Tradewinds Drive., in North Topsail Beach, Onslow County as requested in the permittee's application
package, dated March 18, 2016, and received by DCM on April 22, 2016. This permit, issued on May 3, 2016, is subject
to compliance with the application and site drawings (where consistent with the permit), all applicable regulations,
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: Construction of a residential dwelling with associated amenities and utilities.
(1) All proposed development and associated construction must be done in accordance with the permitted work plat
drawings(s) dated received by the Division of Coastal Management on April 22, 2016.
(2) All 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.
(3) Any change or changes in the plans for development, construction, or land use activities will require a reevaluation and
modification of this permit.
(4) A copy of this permit shall be posted or available on site. Contact this office at [phone] for a final inspection at
completion of work.
(Additional Permit Conditions on Page 2)
This permit action may be appealed by the permittee or other qualified persons
within 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
Jason uau
LOCAL PERMIT OFFICIAL
127 Cardinal Drive Extension
Wilmington, NC 28405-3845
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.
PERMITTEE
(Signature required if conditions above apply to permit)

Name: Topsail Sunrise, LLC
Minor Permit # NTB 16-17
Date: May 3, 2016
Page 2
(5) All buildings/structures shall comply with the NC Building Code, including the Coastal and Flood Plain Construction
Standards of the N. C. Building Code, and the Local Flood Damage Prevention Ordinance as required by the
National Flood Insurance Program. 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.
(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 vegetated and stabilized (planted and
mulched) within 14 days of construction completion.
(7) The amount of impervious surface/coverage on this property shall not exceed 30% within 75 feet of the Normal High
Water line. Additionally, no development shall occur waterward of the Corp of Engineers Waterway Easement line.
(8) All buildings must be elevated on pilings with a diameter of at least 8 inches in diameter if round, or 8 inches to a
side if square; and the first floor level of the sills and joists must meet the 100-year flood level elevation.
(9) All pilings shall have a tip penetration greater than eight (8) feet below the lowest ground elevation under the
structure. The deck shall be constructed independently from the residence and shall be structurally detached.
(10) The pernittee is required to contact the Local Permit Officer [phone], shortly before he plans to begin
construction to arrange a setback measurement that will be effective for sixty (60) days barring a major shoreline
change. Construction must begin within sixty (60) days of the determination or the measurement is void and must
be redone.
(11) Pursuant to 15A NCAC, Subchapter 7J.0406(b), this permit may not be assigned, transferred, sold or otherwise
disposed of to a third -party.
SIGNATURE:
PERMITTEE
DATE:

Coastal Management
ENVIRONMENTAL OUALITY
May 3, 2016
Topsail Sunrise, LLC
c/o Lee Thornton
Thornton Builders & Investments, LLC
PO Box 2083
Surf City, NC 28445
Dear Mr. Thornton:
PAT MCCRORY
Go.nror. -
DONALD R. VAN DER VAART
Secretary
BRAXTON DAVIS
Darcmr
Attached is CAMA Minor Development Permit No. NTB 16-17, for work to be done for Topsail
Sunrise, LLC at 505 Tradewinds Dr., in North Topsail Beach, Onslow County. A copy has been
sent to the Town Inspections Department.
In order to validate this permit, please sign both copies of the permit as indicated for our
records. Retain the orange copy for your files, and sign front and back of the white copy then
return to us within 20 days of receipt, in the enclosed, self-addressed envelope.
This is not a valid permit until it is signed and returned to our office. As the agent for this project
you are authorized to sign the permit for the applicant.
Thank you for your prompt attention to this matter.
Enclosures
Cc: WiRO file
NTB Inspections Dept.
Sincerely,
Shaun K. Si pson
Permit Support Technician
State of North Carolina I Envinnanental Quality I Coastal Management
127 Cardinal Dri" ExL, Wilmington, NC 28405
919 796 7215

NOTI( cz�olj
\J•� f9 CE� �`�.I B��J i��I..J L.J ��1 I-�EI @��'���
APPLICANT: FOR MORE DETAILS CONTACT
THE LOCAL PERMIT OFFICER BELOW:
Topsail Sunrise, LLC NC Div. of Coastal Management
105 So Knightsbridge Rd. 127 CairdinaO Dr. Extension
Cary, NC 27513 Fli ilmingtong NC 25405
Jason Cali, Field Representative
Agent: Thornton Builders, LLC [phone] 91 O.7g5-7221

- NOTES-
-LEGEND-
1.This pwplan Yofen
EIP ExMt,g Iron P'P
existing parcel of NnO.
CP Caicule(ed Polra
2 "ect to restriCaVe
R'W Right-Ot-Way
covenants. assemwNb of
MBL- lAinimum &dltliey Lne
Nmrd zonlp onfe nce, &
"
WMergtwntl uNNm, a any.
S. No title search by mirvsyor.
4. References; MB 50, PG 185
GB 4332, PG 538
5. POW Zone-VE
Community Panel #370/884296 J
8. Zone-R10III CON-D- North Topsail Beach
SeBwcks \
Fm -20'
Skle-1 \
Rear -1a
JACKIE REALTY
HOLDINGS, LLC
DB 4255, PG 904
e-- N60_18'18� 160.18'
EIP tl
LOT 24 & 25
ME 62, PG 233 X
d
A
6
0
4 PARKING SPACES L
BELOW RESIDENCE AND 3
PARKING SPACES AT
CONCRETE DRIVEWAY, c
STUMP SOUND
N62'16'21'E 79,54' _
APPX HWL
LOT 26
0,38 ACRES
POSED
3DENCE &
IL 0.2' FROM
'.EMENT z�cwqscyox-{D�yT�[
tNTRII]V Si$L YAT�kVAl E4SElEl
COVERED
PORCH
389•
3 »� 1 I
AI H
'ROPOSEv
rYeD• ..... 4 1 1 2 1 I
I irNr, rnl sGrAdir{9
N �
m KRYSTALENE S. PEELE
KD CHARLES PEELE
Eo ro DB 2385, PG 119
EIP S60'19'58'W 79.84'
EIP
UNCOVERED
STAIRS
ENCROACH SIDE
SETBACK 4'
LOT 27
ME 11, PG 72
LOT AREA - 16,90E SF (0.38 AC)
PROPOSED RESIDENCE - 2.400 SF
(INCLUDING 12' EAVE)
PROPOSED CONCRETE DRIVE- 1,412 SF
PROPOSED CONCRETE P0CIL, DECKING- 397 SF
TOTAL PROPOSED IMPERVIOUS- 4209 SF (Z4.97.)
IUXIMIM ALLOWABLE IMPERVIOUS- 5,072 SF (30Z>
PROPOSED I-Ir WIDE
CONCRETE DRIVEWAY
2N KK SPLITS INTO 2-1a WIDE
CONCRETE WIVESR/W F[P R/W
N60'25'41'E 2ID.57• EIP S60'09'42'W - 79.82' S59-52'10'W 79.90' EIP
TRADE WINDS DRIVE
50' PUBLIC RIGHT-OF-WAY
R/W
KONn1 CAROLIMA
ONiLOW COINM
1, WESTON LYAIL, PROFESSIONAL LAND SURVEYOR
NUMBER L-443S, CERTIFY THAT THIS PLOT PLAN WAS
DRAWN UNDER MY SUPERVISION FROM AN ACTUAL OPS
SURVEY MADE UNDER MY SUPERVISION FROM (DEED
BOOK 4332, PAGE 536) AND THE FOLLOWING
INFORMATION WAS USED TO PERFORM THE SURVEY:
CLASS OF SURVEY: B; POSITIONAL ACCURACY: 500 RMS;
TYPE OF GPS FIELD PROCEDURE: VRSRT U%P9; DATUM:
NADS3 "ROOT-, NAVDS9; GEOOD MODEL: GEOID 03-
COMBINED GRID FACTOR: 0.9999M93; UNITS: US SURVEY
FEET; THIS IS A SURVEY OF AN EXISTING PARCEL OR
PARCELS OF LAND AND DOES NOT CREp�AR�,.
STREET OR CHANGE AN EXISTING ST .�(y cZ�'�'.r
i
` se��
R/W
40 20 0 40 80
GRAPHIC SCALE
Preliminary Plot Plan for
Robert Dodson
LOT 26, TRADE WINDS DRIVE
GALLEON SAY
NORTH TOPSAIL BEACH, NO
snug SOUND TOWNSHIP, OHSLOIS COUNTY
NALa t•. M Mr R M.
WESTON la"LL, PE, PLS, PLLC
214 HIGHWAY ITN SUM
HOLLY MINE, NC 2""
PNGNE: 91049 9 1 FIRM LICSNY #F0927
SRiI)CiUflAL 8 CML ENGINEERING 8 LANC SURVEYING
RECEIVED
WILMINGTON, NC
PR 2 2 2016

I�T
EMIR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue Braxton C. Davis Dee Fre
Governor Director
Sec
AGENT AUTHORIZATION FORM
Date:
Name of Property Owner Applying for Permit: Name Authorized Agent for this project:
N
017 tl i Vtr lsi l /
( l IA-kn i A; OVC ,AwC-
Owner's Mailing Address:
/DZZ $_
Phone Number) ! CE -71 V
Agent's Mailing Address:
Po 12-o YC 2'D d ?
a8 YYS
Phone Number(gtO) R22-2
I certify that 1 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):
I
VS
For my property located
This certification is valid thru (date)
t
Property Owner Signature Date
2P11b o
RECEIVED
DCM WILMINGTON, NC
APR 2 2 2016

Project is in an:
Property Owner: —
Property Address: —
Date Lot Was Platted:
OCEAN HAZARD AEC 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 cunents. 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 an 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 if they become imminently threatened
by changes in shoreline configuration. The seucture(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 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
feet landward in a major storm.
The flood waters in a major storm are predicted to be about
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 applicant must acknowledge this information and
requirements by signing this notice in the space below. Without
the proper signature. the application will not be complete.
SPECIAL NOTE: I'his 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 of permit 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 re -measured. Also,
the occurrence of a major shoreline change as the result of a
storm within the 60-day period will necessitate re -measurement
of the setback. It is important that you check with die 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 Information, contact.
Local Permit Officer
NC DENR
Div. of Coastal Management
127 Cardinal Drive Ext.
Wilmington, NC 28405-3845
1916) H6
Phone Number
RECEIVED
ReviQ1011110MINGTON, NC
APR 2 2 2016

City, State, Zip Code
Dear Adjacent Property:
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)ertiFle,J Mail Fee f3.30
atra Services & Fees (mecx m., aae ree p 'ere)
❑ %tum Receipt O+erdceoY) s
❑ Return Receipt (electmnic) s 10 00—
❑ cenle d Mal Restncted Oaliveq $ $0_0()_
Ndult Signature Reputed I $0.0o
�bftsignatum Restnded Oa' s •V Vll
tosfa9e $0.47
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This letter is to Inform you that I, ::Q A i 1 C.rASG G GG have applied for a CAMA Minor
5 Property Owner
Permit on my property at SW— rJ-4ICW6+4S ajVIC, inONSLOW
Property Address
County. As required by CAMA regulations, ! 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 cornments about my proposed project, please
contact me at (a58, or by mail at the address listed below. If you wish to
Applicant's Telephone
file written comments or objections with the NC DENR CAMA Minor Permit Program, you may submit
them to:
Jason Dail
Local Permit Officer for North Topsail Beach
NCDENR/DCM
127 Cardinal Drive Extension
Wilmington, NC 28405
MailingPlot
Address
City, State, Zip (Bode
0482
02
Postmark
Here
04/20/2016
DOM WILM NIGTON, NO
APR 2 2 2016

oc n ter
Adjacent Property Oper
f2yMailin�frere��0ss ujnF F%1\
Add
C\C.tL2b 0%
City, State, Zip Co
Dear Adjacent Property:
U.S. Postal Service'"
CERTIFIED MAIL° RECEIPT
Domestic Mail Only
For delivery information, visit our website at t ..usps.come. NIEMEN
LAFKSBURGY r 20871
. 3 rs
Mail Fee f3.30 0482
7 2
NvioesBFees(c/reckbox, sod lee , ere) 02
Receipt rrh.d pyi $R1 ReceiM (efectne7$$0go_Postmark
0a Mail Re Mtn Delivery $HereO'pn w. R dg $lgnswre RestrictedDelvery E
G Nf0.47
to Total Postage and Feea 04/20/2016
a $ $3.77
� send, `r QCc\eti
Sfree�flai0 [ No., or -9on
tdN Stele,ZIP+4a'...................................................................
This letter is to inform you that I, __I Qif�t' (� V'fy %Sc f LI C have applied for a CAMA Minor
Property Owner
Permit on my property at SbS �f2 �T.�Jr�c�c a '� t/C r' "' 6 in ONSLOW
Property Address
County. As required by CAMA regulations, I have enclosed a copy of my perm t 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 (e o q2,2 - 2aS g ,or by mail at the address listed below. If you wish to
Applicants Telephone
file written comments or objections with the NC DENR CAMA Minor Permit Program, you may submit them to:
Jason Dail
Local Permit Officer for North Topsail Beach
NCDENRIDCM
127 Cardinal Drive Extension
Wilmington, NC 28405
Sincerely,
Mailing Address
!�ri P Cu-c nX
City, State, Tip Cade
RECEIVED
DCM WILMINGTON, NO
APR 2 2 2016

ti -W ltr�
Locality
Ocean Hazard Fstuarine Shoreline QKW Sliorelinc -Public Trust Shor:;liae
Z h""`at",�u4xe`g v,. f�•.;.xYy��"tti z�s iE5�ry. r `^' ,C_ c 7sYs�0se,k ,.e.0 AY"tSP %�} Syr� + WSy �"S v
LAND OWNER
Name 'lo�Sca\ 1 S�1lNt LAC
Address Sys
City State OC ZipPhone
Email
AUTHORIZED AGENT
Name —(�rA rftriJ ?5v0c\-c, (4 I�j)vt�\S I L-LC-
Address o g ov- lot .�
City S' C t-SA 1 Statte� r3 - Zip ,Ji q W Phone ( q16) CJ,2.� - d-OS �
Email 4-iV4J0 oc, (AM
LOCATION OF PROJECT: (Address, stfet name and/or directions to site. If not oceanfront, what is the name of the
adjacent waterbody.) SAS
DESCRIPTION OF PROJECT. (List all proposed construction and land disturbance.) Sir\ S\r
C 4J�iNAIC'Ct o ^/
SIZE OF LOT/PARCEL: (P( I OS square feet acres
PROPOSED USE: Residential Il (Single-family ❑ Multi -family Q ) CommerciaVbdustrial ❑ 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 SHE AECs: SIZE OF BUILDING FOOTPRiNTAND 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_
If yes, list the total built upon area/impervious surface allowed for your lot or parcel: r o-i of sqguare BECEIVED
I ` DCM WILMINGTON. NC
3D�1° APR 2 2 2016

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)
Xan owner or record title, Title is vested in OroSlow see Deed Book y 3 3 2
page 5 ?�G in the 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)
(1> —0:'hr` 4 e a3eVe� tti o 6k.tt(r4 -%kk 0_8 c\41 k-Sbv­4A MO ,kmPll
(2) -("fy S {nCL\C_ hot\ ` SY� t 0.d �cC\ibcA� \e� rTtC- S`lb
(3)
(4)
to IA,24_M ilej M1
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 fiuthermore certify that I am authorized to grant, and do in fact grant, permission to Division of Coastal Management stag;
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 / f day ofMM1_k , 20 / to
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 beprovided orally by the applicant. The details of the application as described by these sources are
incorporated without reference in any permit which maybe issued. Deviation from these details will co !z��//'
an ermit. A person developing m an AEC without �ea iNGTONI NO
YP rNPe P 8 � permit is subject to civil, criminal and administrative action.
APR 2 2 2016