NTB_05-60_Melhem

2005/J1UL113A1EII 03:05 PM TOWN N TOPSAIL BEACH FAX No.910 328 4508 P,002
—Nn
Local Government
CAMA
MINOR DEVELOPMENT
PERMIT
as authorized by the State of North Carolina, Deparbrnent of Environment,
and Natural Resources and the Coastal Resources commission for development
in an area of environment concern pursuant to Section 113A-11S of the
General statues, "Coastal Area Management.'
05/60
Permit Number
Issued to Mrs. Margaret Melhem .. authorizing development in Ocean Hazard AEC at, 153 Ocean View Lane,
North Topsail Reach, NC 28460 as requested in the permittee's application, dated June 6. 2005. This
permit, issued on lulu 1. 2005 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 vold.
OCEAN HAZARD AEC 15 NCA.0 7EL0300
RE5IDENTJALDEVELOPMLNTINAN OCEAN HAZARD AEC
TUyspermit autJwtises the consbuciion a singlefamily dweAingwith landscaping and driveway.
1. The structure shall comply wi9:t the NC Building Code, including the Coastal and FloodPlain Contraction
Standards, Chapter 34, Volume 1 or Section 39, Volume I-B, and the Local Flood Damage Prevention Ordinance as
required by the National pleadrnUarance Program. If any provisions of the building coda or a flood damage
prevention ordinance are fixor scent with any of the following AEC standards, the more restrictive provision shall.
control. All Fwosed development out associated construction must be done in accordance with the drawings as
submitted on June 6.2005.
2. The structure must setback 60 feetfrout the 5rst line of stable natural vegetation
3. The structure mustbe located entirely off of the frontal dune, and if a primary dune is present, behind the crest of the
primary dime.
Conditions continued on second page
This permit aclion may be appealed by the permittee or other
qualified persons vMn 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 penrdt
oflfcerwhen the pmjed is krepecied foroompfance,
Any malydenance work or projed modification not covered under
this pann0, require further written pwnR approval.
All work must cease when this permit expires on December 31,
2tf08
In hsu'mg this pewit it is,ageed that this purled Is consistent with
the local Land Use Plan and all 2WIceble ordinances.
This psnnq may not be transferred to another party Without the
written approval of the DIv51on of Coastal MawD t AnL
Sue Mclaughli
CAMA Local Patmit Official
Penni3ea (signature requited h wridfions alcove apply to permit)

2005/J.UI./13/P`0 03:05 PM TOWN N TOPSAIL BEACH FA'A No.910 328 4508 P.003
Name: MELHEM
Minor Permit: #05160
Date: 07/01/05
4. The structure must be elevated on pilings with a diameter of at least 8 iuches.and the first floor level of the siAs and
joists must meet the 100-year flood level elevation.
5. All pilings shall have a tip penetration greater Ifisra eight feet below the lowest ground elevation under the structure.
For those structures so located on the primary dune or nearer to the ocean, the pilings must extend to five feet (5+)
below mean sea level
6. No impermeable surfaces shall be allowed over any functional part of the septic tank system.
7. Dune disturbances will be allowed only to the ertem necessary for development and if the dune's protective value is
not weakened or reduced Diedubed areas will be immediately stabilized.
S. This permit maybe renewed for one (1) year if requested before the expiration date.
9. The amount of built -upon area shall be limited to no mare than 30% of the ABC area of the land to be develgped, in
this case Ala square feet C Storm Permit #931220 Iimits the coverage to this amount.
10. Pursuant to 15 NCAC, Subchapter 7J.0406 (b), this permit may notbo assigned, trans£ercrxi, sold or otherwise
disposed ofto a flrfid party.
11. This permit other than those shown on original plot designpermits no additional covered structures,
12. The permitted is required to contact the Local Permit Officer shortly before heplans to begin construction. to arrange
a setback measurement which will be effective for sixty (60) days barring a major shoreline change. Construction
new begin within sixty (60) days of the determination or the measurement is void and must be redone.
13. Sand used to strengthen dunes must be brought in from an outside source andmust be of the same nature as the sand
in the area which it is to be placed. No sand is to be removed from the lot
14. Sand held in storage in any dune, other than frontal or primary dimes, maybe moved laterally in order to sir 4fban
existing primacy or frontal dunes if the work would enhance the protection to the proposed development activity and
the send is mancdiately stabilized.
15, All development mustbc consistent with all -applicable Federal, State and Local Standards.
16. Any structum authorized by this permit shall be relocated or dismantled when itbecomes imminently threatcnedby
changes in shoreline configuration The st uctnre(s) shall be relocated or dismantled within two veers of the time
when it becomes imminently Ireatened, and in any case upon its collapse or subsidence. However, if natural
shoreline recovery or beach renoudshment takes place within two years of the time the stractruc becomes
imminently threatened, so that the structure is no longer imminently (hreatened, than it need not be relocated or
dismantled at that time_ This condition shall not affect the permit holder's right to seek antborizatiou of temporary
protective measures allowed under CRC rules.
17. Any change or changes in the plans for development, construction, or land use activities wM require a re evaluation
and modification of this permit
18. A cowof this permit mast be posted on the rrei)SM during c stmefton Please call r910-328-13491 for final
inspection.

168474 Affidavit of Publication
15074696 Jacksonville Daily News
1 of 2 Jacksonville, NC
PersonaliyAvReared before me, a ary Public of the County of Onslow, State of North Carolina, on this the 8th day of
June, 2 5
of The Daily News, who being duly sworn, states that the advertisement entitled CAMA - MELHEM, MR & MRS. a true
copy of which is printed herewith, appeared in The Daily News, a newspaper published in the City of Jacksonville, NC,
County of Onslow, State of North Carolina, 1 day n the following dates.
June 8, 2005
NORTH CAROLINA
ONSLOW COUNTY
NOTICE OF FILING
OF APPLICATION
FOR CAMA MINOR
DEVELOPMENT PERMIT
Pursuant to NCGS 113A-119 (b), the Town of North Topsail Beach, a locality authorized to issue CAMA permits in
Areas of Environmental Concern, hereby gives NOTICE that on June 6, 2005, Mr. & Mrs. Melhem, applied for a CAMA
permit to construct a Single Family Dwelling with beach access at 153 Oceanview Lane, North Topsail Beach, Onslow
County, North Carolina. The application may be inspected at the address below. Public comments received by June
20, 2005, 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 #05/60
Sue McLaughlin, CAMA
Local Permit Officer
Town of
North Topsail Beach
2008 Loggerhead Court
North Topsail Beach,
NC 2a460
June 8, 2005
ACM ECEJVE
WlLMINrTC o C
J11
N 2 1 700S

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Vo
RECEIVED
DCM WILMINGTON, NC
y
APPLICATION FOR
CAMA MINOR
DEVELOPMENT
PERMIT
In 1974, the North Carolina General Assembly passed the Coastal Area
Management Act and set the stage for guiding development in fragile
and productive areas that border the state's sounds and oceanfront. Along
with requiring special care by those who build and develop, the General
Assembly directed the Coastal Resources Commission (CRC) to imple-
ment clear regulations that minimize the burden on the applicant.
This application for a minor development permit under CAMA is part
of the Commission's effort to meet the spirit and intent of the General
Assembly. It has been designed to be straightforward and require no
more time or effort necessary from the applicant. Please go over this
folder with the Local Permit Officer (LPO) for the locality in which you
plan to build to be certain that you understand whatinformation he or
she needs. 'S
Under CAMA regulations, the minor permit is to be issued within 25
days once a complete application is in hand. Often less time is needed if
the project is simple. The process generally takes about 18 days. You
can speed the approval process by making certain that your application
is complete and signed, that your drawing meets the specifications given
inside and that your application fee is attached.
Other permits are sometimes required for development in the coastal
area. While these are not CAMA-related, we urge you to check with the
Local Permit Officer to determine which of these you may need. A
listing is included on page 2 of this folder.
r
n
O
r
>O
JUN 2 1 2005 We appreciate your cooperation with the North Carolina Coastal Man-
agement Program and your willingness to build in a way that protects
the resources of our beautiful and productive coast.
Coastal Resources Commission
Division of Coastal Management
a

Locality Ir` QrVI0i,k) t A(V0 Permit Number S (06
Ple
t Ocean Hazard ✓ Estuarine Shoreline _ORW Shoreline _Public Trust Shoreline —Other
pe
re (For official use only)
RECEIVED
pl. GENERAL INFORMATION DCM WILMINGTON, NC
LAND OWNER
JUN 2 1 2005
Name_%%//hem l 10aiy4.eef �G��Zcih
Address le (o /6 Wer l6'-'t ob a CT
PF City 127ele-OA, State ✓A Zip cR8lOI Phone ?o3 f393-9,23V
If)
AUTHORIZED AGENT
Address
City /Ads F2/L�State lVe, Zip 2S'Y1o0 Phone 3,27-03sa
LOCATION OF PROJECT: (Address, street name and/or directions to site. If not oceanfront, what is the name of
If) the adjacentwaterbody?) %S3 DCCRNU/eW //,tee, �Lor 23 Oeew10 L7 ii u�)
DI DESCRIPTION OF PROJECT. (List all proposed construction and land disturbance.)
6'z'51/luc/ J YAiliilu 1is��Nc� /iyQGcorc�Grcc aik�ed nlo� nlen�.
SIZE OF LOT/PARCEL: 937 D7(i square feet • 79 acres
PROPOSED USE: Residential ✓ (Single-family _ Multi -family _) Commerical/Industrial
Other
NC TOTAL ENCLOSED FLOOR AREA OF A BUILDING IN THE OCEAN HAZARD AREA OF ENVI-
RONMENTAL CONCERN (AEC): 4!-`-80 square feet (includes all floors and roof -covered decks)
Ha
SIZE OF BUILDING FOOTPRINT AND OTHER IMPERVIOUS OR BUILT -UPON SURFACES IN
THE COASTAL SHORELINE AREA OF ENVIRONMENTAL CONCERN (AEC): "K 0-2 0 sq. ft.
(Calculations include 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.) 2 O go pv., c I c. d aeJ
Choose the AEC area that applies to your property: y qyo Pa Feed Dr y
(1) within 75 feet of Normal High Water for the Estuarine Shoreline AEC -- o SON k, ;4�
(2) within 575 feet of Normal High Water for the Estuarine Shoreline AEC, adjacent to Outstanding
Resource Waters y o alvig4
(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 STORMWATER MANAGEMENT PERMIT. Is the project located in an area subject to a
State S�°rmwater Management Permit issued by the N.C. Division of Water Quality? q�/i2sZV
YES ✓ NO
L g „ i-are feet.
If yes, list the total built -upon azea/impervious surface allowed for your lot or parcel. � al

P.01/01
TRANSACTION REPORT
2005/JU14/06/M0N 14:38
FAX(TX)
# DATE START T. RECEIVER COM.TIME PAGE TYPE/NOTE FILE
01 JUN/06 14:37 Ivally News -Classifieds 0: 0 0 : 33 1 1 1 OR ECM 2936
- NOTICE OF FILING
OF APPLICATION FOR MINOR DMLOPMENT
PEPIAM
pursuant to NCGS 113A-119(b), the Town of North Topsail Beacocality authorized
h,
g[ves NOTICE that
to issue CAMA permits in Areas of Environmental Concern' pit to a construct a Single
on June 6, 2005,1& & Mn- Melhetn, applied
Family Dwelling with beach access at 153 Ocean view Lane, N� Topsail
ddeess below.
Onslow County, North Carolina. The application may si inspected
Public comments received by June 20, 2005 will be considered. Later comments will be
accepted and considered up to the time of permit decision. Project modifications may
wille provided upon written regncomm�' PEhEMIT # OS/60ce of the permit decision in this matter
Sue McLaughlin
CAMA, Local Permit Officer
Town of North Topsail Beach
200g Loggerhead Court
North Topsail Beach, NC28460
Please print on June 8, 2005.
RECEIVED
DCM WILMINGTON, NC
JUN 2 1 2005

- NOTICE OF FILING
OF APPLICATION FOR CAMA MINOR DEVELOPMENT
PERMIT
Pursuant to NCGS 113A-119(b), the Town of North Topsail Beach, a locality authorized
to issue CAMA permits in Areas of Environmental Concern, hereby gives NOTICE that
on June 6, 2005, Mr. & Mrs. Melhem, applied for a CAMA permit to a construct a Single
Family Dwelling with beach access at 153 Ocean view Lane, North Topsail Beach,
Onslow County, North Carolina. The application may be inspected at the address below.
Public comments received by June 20, 2005 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 # 05/60
Please print on June 8, 2005.
Sue McLaughlin
CAMA, Local Permit Officer
Town of North Topsail Beach
2008 Loggerhead Court
North Topsail Beach, NC 28460
RECEIVED
DCM WILMINGTON, NC
JUN 2 1 2005

Melhem F. Melhem
Margaret W. Melhem
6618 Weatheford Court
McLean, VA 22101
June 4, 2005
To Whom It May Concern:
Russell Prince is our authorized agent for the purpose of obtaining permits, to include
the CAMA permit, as required to build our home in Ocean Sound Village, North
Topsail Beach, NC.
Melhem F. IMelhem
garet W. Melhem
RECEIVED
DCM WILMINGTON, NC
JUN 2 1 2005

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(76.85'
RECEIVED
DCM WILMINGTON, NC
JUN 2 1 2005
Site BM
Elev. 3.34
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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to F. & Margaret Melhem's
property located at 153 OceanView Lane (Lot 23 OceanSound Village)
across from the Atlantic Ocean , in North Topsail Beach, North Carolina.
They have described to me, as shown below, the development they are planning at that
location and I have no objections to his proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
Build single family residence in accordance with attached plot plan.
RECEIVED
DCM WILMINGTON, NC
JUN 2 1 2005
Robert F. Gerkens
7574 Stein Road
Zionsville, PA 18092
Owner of:
157 OceanView Lane
Signature
Print or Typed Name
Telephone Number
Date

FS
ATEME
I hereby certify that I own property adjacent to F &Margaret Melhem's __
property located at 153 OceanView Lane (Lot 23 OceanSound Village)
across from the Atlantic Ocean in North Topsail Beach, North Carolina.
They have described to me, as shown below, the development they are planning at that
location and I have no objections to his proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
Build single family residence in accordance with attached RECEIVEDplot plan.
DCM WILMINGTON. NC
Jeffrey & Elizabeth Ubinger
321 Blue Run Road
Cheswich, PA 15024
Owners of:
149 OceanView Lane
JUN 2 1 2005
Signature
Print or Typed Name
Telephone Number
Date

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RECEIVED
[)CM VWILMINGTON, NC
JUN 2 12005

I•
AEC HAZARD NOTICE
Project Is In An: __ Ocean Erodible Area _' - High Hazard Flood Area _ Inlet Hazard Area
Date Lot Was Platted: 199,.p _._-
1 his ❑oua is Intended to make sou, tht ipic icant, etvarc
Of the special rink, and coodi ions .; ociatQd with
development in this area• which e, >u! it:t fo natural
hazards such as storms, erosion and curicnts. 1 tie rules of
the Coastal Resources Commi,Fion r•-ou,re t!tat you
receive an .AEC Fla -'aid \on - n� rim tJ " iha!
notice in writing before i perms; to, d,•. p rut a.; "e
iuued.
The Commi,sion's ni I is on bui { d mgs la u..:ude, acc•an front
setbaeksanddune alteration areclesigned �;�minnnize.but
not eliminate, propt•rty loss tram R.• grnGnr;
permits, the Coastal Resoures Cothran,,i, m does not
guarantee the safely of the dete!opmet" and issumes mo
liability for future damage to the deN 001 rent.
The best available information a, a -,cep, 0 h% the C (esnmi
Resources Commission, eldicate, that th, anoun: licear
erosion rate for the area where vnur protest y is is
feet per year.
The rate was established by careful aerial
photographs of the coastline taken over tot pact SO Years.
Studies also indicate that th( h lr-_l;n,. u 1 mo,_ as
much as jS"Ueet landward in a m::jnr ;.•rn?.
the floodwaiersinamajorstvrmareprc i_ieciwbeaNml
_j"eet deep in this area.
Preferred oceanfront protecli m m niva.,u r a1,- I)Vach
nourishment and relocation ot threat"Tw3structures.
Hard erosion control structure., such a, hulkheapa.
seawalls, revetment, groins, jetties and oreakwatcrs are
prohibited.Temporar) devices, include , s::ndhags.matt
be allowed under certain conditions.
This structure shall be relocated or d isma! , J k-d %o i thi n twU
-years of becoming imminently threatenv 1.
The applicant must acknowledge this umtorinatian and
requirements by signing this notice in the below space.
Without the proper signature, the applicatirin wil! not he
complete.
Applicai�
w 7, Zoo 5 ----
Date
SPECIAL NOTE: i'9.� hazard notice i,
&velopmenl it areas >ut'lect to sudden. arnl + ._
storms anderosio n.!'r•rnutsissuedlurdeX io}'tnr'. ..
areae*preon December 11 of the third yearlollom utr the
vear it, which the permit uva> issued. Shortic beloi, .: rrk
lxgins or, ibi, prole:'. site, the Loca! Permit 0!ft _-' :•;ill
detennnu•tht c �.tuuonhoeandsetback distancca•
sit( 11 thi l=till ert', t':ai smell little chin r anti ti , j -. ..
development <an gull meet ttic uthad• redutu n i
LPOwill inform youthatyoumayIMgumwork 1;i,:r
scent that von check with the LI'o'zniorc thepertim v.-n^-
forofficial apprt,�a! to rnnU sue the work after hi n.:re,u
ha, ecptred. Cwneralh•, it foundation pilings hair',men
placed and substantial progress is continuing perm;t
renewa: may not Ix necessary. If stiI stannal h o
not rx'e.n m:adc, the permit must be ri cowed an,.
,etback ire citahii,hcd It is emlawfui to c :nt:n,.
after M'rinft e?F'irat on without t,ni
for more information, contact:
k ILA
'— - ---
Address
Lo�ati:y
Phone
RECEIVED
DCM WILMINGTON, NC
JUN 2 1 2005
Revisec ' '93

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-famllyresidential struc-
tures greater than 5,000 square feet and non-residential
structures greater than 5,000 square feet) must be setback
from the first line of natural stable vegetation a distance
equal to 60 times the annual erosion rate or 120 feet,
SETBACK I SETBACK II�FIRST LINE OF
----�-- STABLE
ALI 30 x ANN ALI
BOB(AVERAGE
Q
AVERAGE VEGETATRIOAL
(EROSION I EROSION
I RATE I
000
IRATE
I I I
I
(LARGE
(WALL
ALL
I STRUCTURES)
BEFORE YOU BUILD
Setting Back for Safety: A Guide to Wise Development Along the Oceanfront
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 protecting 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 enlarged by 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 CAMA, 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
REGF— EDareaascalculatedfromvegetationline
VA WILMINGTO�1tlNPlength needed to extend 4 feet below MSL
JUN 2 1 2005
PRE -PERMIT STRUCTURE; INADEQUATE SETBACK
PERMITTED PRE -STORM BEACH PROFILE
STRUCTURE;
ADEQUATE POST -STORM BEACH PROFILE
SETBACK 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 survtvat.

) THERR PERMITS MAY BE REQUIRED: The activity you are planning may require permits other than the CAMA minor
a
.veloprnerit permit. As a service we have compiled a list of the kinds of permits that might be required. We suggest you check over the list
^�
ith your LPQ to determine if any of these apply to your project: Zoning, Drinking Water Well, Septic Tank (or other sanitary waste
eatment system), Building, Electrical, Plumbing, Heating and Air Conditioning, Insulation and Energy Conservation, FIA Certification,
and Dune, Sediment Control, Subdivision Approval, Mobile Home Park Approval, Highway, Connection, and others.
y
0
z
TATEMENT OF OWNERSHIP:
I_
the undersigned, an applicant for a CAMA minor development permit, being either the owner of property in an AEC or a
arson authorized to act as an agent for purposes of applying for a CAMA minor development permit, certify that the person
;ted as landowner on this application has a significant interest in the real property described therein. This interest can be
!scribed as: (check one)
cr/
an owner or record title. Title is vested in /&Ihim /"7 Y h ,x,4 re: M , see Deed Book
r
age 'Y01 in the OyJ/OW County Registry of Deeds.
_an owner by virtue of inheritance. Applicant is an heir to the estate of
robate was in County.
_if other interest, such as written contract or lease, explain below or use a separate sheet and attach to this application.
10TIFICATION OF ADJACENT PROPERTY OWNERS:
furthermore 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.
(Name)
3)
(Address)
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 to
osion and/or flooding. I acknowledge that the local permit officer has explairkee lar hazard problems associ-
ed with this lot. This explanation was accompanied by recommendationtMI nNe floodproofing tech-
ques.
ERMISSION TO ENTER ON LAND: JUN 2 12095
furthermore certify that I am authorized to grant and do in fact grant permission to the local permit officer and his agents to
ater on the aforementioned lands in connection with evaluating information related to this permit application.
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his application includes: general information (this form), a site drawing as described on the back of this application, the
vnership statement, the AEC hazard notice where necessary, a check for $100.00 made payable to the locality, and any infor-
ation as may be provided orally by the applicant. The details of the application as described by these sources are incorporated
ithout reference in any permit which may be issued. Deviation from these details will constitute a violation of any permit. Any
!rson developing in an AEC without permit is subject to civil, criminal and administrative action.
This the /sr day of 2065- Q
Landowner or person authorized t act as his agent for purpose of filing a CAMA permit application. C