TB_04-24_Dombropskie

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&C 12-S �c� --0 �
Topsail Beach �rJ
Local Government I l`(0p1
Jn
CAMA
MINOR DEVELOPMENT
PERMIT
as auftwind a the State of NO U Carolina, Departnwsint of Env60nhent,
and Natural Resources and the Coastal Resources Corrrmiesim for development
in an area of envYonnent concern pursuer* to Section 113A-118 of the
General Statues,'Coastal Area Marrainmenr
24-04
Permit Number
Issued to Nicholas/Anne/Robert Dombroskie, authorizing development in Estuarine Shoreline at 112 McLeod
Avenue as requested in the permittee's application, dated 9-29-04. This permit, issued on 11-16-04 , 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 an addition of IOW0' deck to rear 0 home at 112 McLeod Avenue
(1) All proposed development and associated construction must be done in accordance with the permitted
work plat drawings(s) dated received 9-29-04.
(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.
Conditions continued on second page
This permit action may be appealed by the pemritlee or other
qualified persom within twenty (20) days of the issuing date. From
the date of an apped, any work conducted under this permit must
cease until the appeal is resolved.
This pe nit must be on the project site and accessible to the permit
offices when the project is inspected for compliance.
Any maintenance work or project modification not covered under
this permit, require further written perm t approval.
All work must cease when this permit expires on
December 31, 2007 ,
In issuing this pond it is agreed that this project is consistent with
the local Land Use Plan and all applicable ordinances.
This permit may not be t ansiered to gather party without the
written approval of the Division of Coastal Management.
Janes L Cahady
CAMA Local Permit Official
820 S Anderson Blvd.
Topsail Beach, N. C. 28445-9831

Cr(apY
Name:
Nicholas/Anne/Robert/
Dombroskie
Minor Permit # 24-04 Pg 2
(4) The footprint of proposed deck shall not exceed 200 square feet, and shall not be covered or enclosed,
now or any time in the future.
(5) Prior to initiating land -disturbing activities, adequate sedimentation/erosion control measures must be
employed to prevent the movement of unconsolidated materials into the marsh or water. This measure
must remain in place until such time as the area is properly stabilized with vegetated cover.
(6) A copy of this permit shall be available onsite for regulatory inspection.

Topsail 132ach 24-04
Local Government O Permit Number
MINOR DEVELOPMENT
PERMIT
as autlrorimd M the Slate of North CwoNrW Deparbne n: of &Mron nent,
and Natural Resources and the Coastal Resources Commission for deedapment
in an area of a nviramnent concern pursuant to Sadden 113I1-118 of the
General SLalues, "Coastal Area Haragernent'
Issued to Nicholas/Anne/Robert Dombroskie, authorizing development in Estuarine Shoreline at 112 McLeod
Avenue as requested in the permittee's application, dated 9-29-04. This permit, issued on 11-16-04 , 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 an addition of 10'x20' deck to rear of home at 112 McLeod Avem a
(1) All proposed development and associated construction must be done in accordance with the permitted
work plat drawings(s) dated received 9-29-04.
(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.
Conditions continued on second page
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 permit must
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 modification not covered under
this permit, require further written permit approval.
All work must cease when this permit expires on
December 31, 2007 ,
In issuing this permit it is agreed that this project is consistent with
the local Land Use Plan and all applicable odnarxx;s.
This permit may not be transferred to another party, wittW the
written approval of Me Division of Coastal Management.
Jaynes L Canady
CAMA Local Permit Official
820 S Anderson Blvd.
Topsail Beach, N. C. 28445-9831
910326,Wl
Permittee (signature required 6 conditions above apply to permit)

Name:
Nicholas/Anne/Robert/
Dombroside
Minor Permit # 24-04 Pg 2
(4) The footprint of proposed deck shall not exceed 200 square feet, and shall not be covered or enclosed,
now or any time in the future.
(5) Prior to initiating land -disturbing activities, adequate sedimentationlerosion control measures must be
employed to prevent the movement of unconsolidated materials into the marsh or water. This measure
must remain in place until such time as the area is properly stabilized with vegetated cover.
(6) A copy of this permit shall be available onsite for regulatory inspection.

OCT 0 4 2004
DIVISION O�nna NT
COPY
Address -�Y O I Ti t5 KC� K f l I l L c:k
City -BeL- A- I zZ Snre 1 kD Zip Z lU it} Phone 4/ 0 - 838" 6 1 %8
l e.
Name Z: v sK(C
Address I PS 6112DI� 4-ILL Cl-,
cityeF)&L- A-02- State A-Q) Zip !26'b pion 400-838-�0198
LOCATION OF PROJECT: (Address, sweet name and/or directions to size. If not oceanfront, what is the name of
theadjaeen--� cwaterbody?) I I fA tAJQI'lu-c- a IQP5gA I i /y/C.
DESCRIPTION OF PROJECT: (List all proposed construction and land )
SIZE OF LOTIPARCEL: (r fQQQ square feet acres
PROPOSED USE: Residenri2l-2L (Single-family X—Multi-family—) Commerical/Industrial
Other
TOTAL ENCLOSED FLOOR AREA OF A BUILDING IN THE OCEAN HAZARD AREA OF ENVI-
RONMENTAL. CONCERN (AEC): A— square feet (includes all floors and roof -covered decks)
SIZE OF BUILDING FOOTPRINT AND OTHER IMPERVIOUS OR BUTLT UPON SURFACES IN
THE COASTAL SHORELINE AREA OF ENVIRONMENTAL CONCERN (AEC): —�F - sq. &
(Calculations include the area of the roof/drip line of all buildings, drivewsys, covered decks, concrete or masonry patios;
etc. that are within the applicable AEC. Attach your calculations with the project drawing.)
Choose the AEC area that applies to your Propertr-
(1) within 75 fen of Normal High Water for the Estuarine Shoreline AEC
(2) within 575 feet of Normal high Water for the Estuarine Sboreline AEC, adjacent to Outstanding
lI csource Waters
(3) within 30 feet of the public Trust Shoreline AEC
(Contact your Local Permit Officer if you are not sure which AFC applies to your property.)
STATE STORMWATER MANAGEMENT PERMIT- Is the project Iocated in an area subject to a
State Stotrnwater Mang meat Permit issued by tits N.C. Division of Water Quality?
YES— NO
If yes, list the total built -upon area/impervious surface allowed for your lot or parcel_ square fccc.
s.

...., ..... - _ . _ 4
TIER PERMITS MAYBE REQUIRED; The activity you are planning may require pertain other than the LAMA minor >
velopnoent permit Asa service we have compiled a liar of the Jdnds oFpermin that migbt be required. We t you check over the list
thyour LPOto determine ifany of These apply to your project: Zoning, Drinking Water Well, ScpticT tarywaste
ncnenr sysrcm) Building, Electrical, Plumbing, Heamigand Aix Conditioning, Insulation and Emtetgq rrtificadon,
nd Dune, Sediment Control, Subdivision Approval, Mobile Homc PO*Approval, Highway, Conned d o
TAMWENT OF OWNERSHIP: �t�,,
the undersigned, an applicant For a CAMA minor development prmair, being cithcr the Ova�r✓B��prW1 in anyAEC or
zson authorized to acr as an War for purposes of applying for a CAMA minor development permit, ape n
an
red as landowner on this application has a A;nifi=t interest in rlte real property described therein. This 'yF scribed as: (check One) N
r or record de. Tide is vested in h- � 05e 4 , see Deed Book �- %
P [tge rn the �� County Registry of Deeds_
,an owner by virtue of inheritance. Applicant is an heir to the estate of
obarc was in County.
if other interest, such as written contract or lease, explain below or use a separate sheer and attach to this application.
[OTIFICATION OF ADJACENT PIIOPERTM OWNERS: ltnuw.wei� h 5ys C�Pr ° b�l""'0� A4-m
krthermore certify that the following persons are owners of properties adjoining this property. I affirm that I have given
CTUAL NOTICE to each of them concerning my intent to develop this property and to apply for a CAMA permit
0
1�
3)
OR DEVELOPERS IN OCEAN HAZARD AND ESTUARINE HAZARD AREAS -
acknowledge that the land owner is aware that the proposed development is planned for an area which may be susceptible ro
osion and/or flooding. I acknowledge that the local permir officer has explained to Inc the particular hazard problems associ-
ed with this lot. This explanation was accompanied by recommendations concerning stabilization and floodproofing tech-
:ques.
ERMISSION TO ENTER ON LAND-
Currhermore certify that I am, authorized to grant and do in fact grant permission to the local permit o&ictx and his agents to
-ter on the aforementioned lands in coanecdon with evaluating information related to this permit application.
his application includes: general information (this form), a site drawing as described on the back of this application, the
Amership sratemenr, the AEC hazard notice where necessary, a check for $100.00 made payable to the locality: and any infor-
mation as may be provided orally by the applicant. The details of the application as described by these sources are incorporated
ithoUC reference in any, permit which may be issued. Deviation from these details will constitute a violation of any permit Any
scan developing in an AEC without permit is subject to civil, criminal and administrative action.
Laadowrrer or person authorized to as as his agent for purpose of filing a CAMA permit application.

09/09/2004 15:01 FAX [phone] TORN OF TOPSAIL BF:ACK LM Ulu
SITE DRAWING/APPLICATION CHECKLIST
Please make sure your site drawing includes the following information required for a CAMA minor development
permit. The drawing may be simple and not necessarily to scale. The Local Permit Officer will help you, if
requested.
PHYSICAL DBAENSIONS
✓ Label roads
Label highways right-of-ways
Label local setback lines
y,' Label any and all structures and driveways currcnrly existing on property
PHYSICAL. CHARACTERISTICS
Draw and label mean high water mark
Draw ksration of on -site wastewater system
If you will be working in the ocean hazard area:
AM Draw and label dune ridges (note height)
A(A Draw and label toe of dune
"AIA- identify and locate first line of stable vegetation
_. Draw and label setback line under LAMA
lyk Draw and label topographical features (optional)
If you will be working in an esr urine shoreline area:
Draw and label landward limit of AEC
_ lY,t — Describe terrain (slope)
DEVELOPIa(Wr PLANS
✓ Draw and label areas that will be disturbed
_ If a house is ro be placed on lot, describe location of house
' Note size of piling and depth to be placed in ground
NA Draw and label all areas to be paved or graveled
✓ Describe composition of surface
MA , Note and list fully all trees and vegetation to be removed or reiocated
W Show landscaping
NOTE TO APPLICANT
Have you:
• completed all blanks and / or indicated if not applicable?
• notified and listed adjacent pmpaty owners?
• included your site drawing/
• signed both apppplication and statement of awnership?
• enclosed the $ I00.00 fee?
• completed an AEC hazard Notice, if necessary?
FOR STAFF USE
Site Notice Posted Final Inspection Fee Received
Site inspections
Dare of Action; Issued Fxernpted
Revised 312003
Denied Appeal Deadline (20 days)

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rp. 2004 15:01 FAX e103281560 TOWN OF TOPSAIL BEACH
ADJACENT PROPERTY OWNER STATE.NEE�a�✓T
I hereby certify that I own property adjacent to Dc` m "
(Name of Propem Owner
Property located at 1 lock, Road, L"w) J�
Tbey bave described to me as shown below.
objections devtot his t tproposal.ev
proposing at that location, and,
DESCRIPTION AIND/OR DRAWING OF PROPOSED
DE'b'ELOPMENT
(To be filled in by indlAdual proposing development)
Q�cL 4,,>2, oC 10' )(ZO' desk/ � (-, qc,-r Of kc-7)-)( .
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OCj p 4 2p04
DIVISION OF EMENT
COASTAL MAN
Signature of Adjacent O7,per
print or Type Name
Telepbone Number
Date

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ROBERT & COLLEEN DO:!BROSKJE
18 BROOK HILL COURT
BEL AIR, MARYLAND 21014
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09%U9!2UU4 15:U1 YAA Ul UJX0IZVU IURV Vi'-1UYJAIL ncecn BIUUU
ADJACENT PROPERTY OWNER STATEMENT
nVJcifvc>NE/4Cu13t�Vr-
I hereby certify that I own property adjacent to is cI P,.rn 5K /E 's
{Name of Property Owner
Property located at
(Lot, Block, Road, etc.)
on _�L A J in (�� t t ��c�cLc N.0
They have described to me as shown below, the development they are
proposing at that location, and, I have no objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED
DEVELOPMENT
(To be filled in by individual proposing development]
"d4-,, of (O' x zoo dul-' 4c, r2a-r o f kbrnt ,
I- -1 LO-1 It J t oon51-r,,-c 4-F_ d
[L"J-VAlac-i 0.nd WI It 6Q.
I�0BI'V's
0CT 4 2004
[),VISION OF GEMEN T
COASTAL M
C_rF I +F_{'/
t.�r�CoVi�-rF_� Cno 2�>
Signature of Adjacent Owner
Print or Type Name
Telephone Number
Date

Aa(
At.
Pl;-oloos ed o¢c//%
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pa rch
ROBERT & COLLEEN D0.MBRO&KIE
18BROOK HILL BEL AIR, MARYLACOURT1014
aopc6
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:'\.Df5T Box J.
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Mc Leod A A,
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DIVISION F
3TAL MAh1iA
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110 A.(

p ! OCT 0.4
-l-i ojoos ed Dec o DIVISION
/a)(xo, C STAL MANA�e
parch
ROBERT & COLLEEN DOMBROSME
18 BROCK HILL COURT
BEL AIR, MARYLAND 21014
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12 x 12"
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OLLFFN DO%MROSKIE
DOK 14ILL COURT
, MARYLANU 21014

MATERIALS LIST
FOR
112 MCLEOD AVE.
TOPSAIL BEACH, NC
1. All wood to be pressure treated lumber
2. Fasteners and nails shall be galvanized
3. Joist shall be fastened with joist hangers
4. Bolts shall be'/2" galvanized, spacing as per plans
5. Materials sized as per plan
�(0 u
OCT 0 4 2004
DIVISION OF
COASTAL MANAGEMENT
ROBERT & COLLEEN C.C.'°[_'!?=E
18 BROOK HILL COURT
BEL AIR, MARYLAND 21014

Q9:08!2004 15:01 YAA VIV040100V ♦„nn or ♦moron.•.
ADJACENT PROPERTY ONSVNER STATEMENT
I hereby certify that I own property adjacent to i] )A AOCL, 'KIc 's
{Name of Property Owner
Property located at J�-
(Lot, Block, Road, etc.)
on m, (`ccA AJx- in : +I Bee—d N.0
They have described to me as shown below, the development they are
proposing at that location, and, I have no objections to this proposal.
DESCRIPTION AND/Olt DRAWING OF PROPOSED
DEVELOPMENT
(To be tilled in by individual proposing development]
ld.d, ,-, ) J� 10' x 0' d eLt 4c- rea-r 0
z -4 U-)I It 6e
[L"n 0-r\J WI I bL
M'M
y V OC, 0 4 W
DIVISION GEMENT
COASTAL MA
c>( h-d
LILY\CDVC.•r-k-J Clio
Signature of Adjacent Owner
l Kvi.c�
Print or Type Name
Telephone Numbcr J�
Date

ECEIVE
OCT 0 4 2004
DIVISION OF
COASTAL MANAGEMENT
NOTICE OF FILING
OF APPLICATION FOR
CAMA MINOR DEVELOPMENT PERMIT
Pursuant to NCGS 113A-119(b), Town of Topsail Beach, a locality authorized to issue
CAMA permits in Areas of Environmental Concern, hereby gives NOTICE that on
9-29-04 Robert Dombroskie applied for a CAMA permit to:
Construct a 10'x 20 deck to rear of home located at 112 Mcleod Avenue , Topsail Beach,
NC, Pender County
The application may be inspected at the address below. Public comments received by
October 25, 2004 will be considered. Later comments will be accepted and considered
up to the time of permit decision. Project modifications may occur based on further
review and comments. Notice of the permit decision in this matter will be provided upon
written request.
CAMA PERMIT # 20-08
Please publish on 10-6-04
Canady, CAMA Local Permit Officer
Town of Topsail Beach
Address: P. O Box 3089 Topsail Beach. NC
28445
Phone: [phone]

TW-iM3@AWAMJAT2A03