57-17 Jones Island Preserve LLC

•
Locality LU,t5 3i n ( Permit Number lb j
. Ocean Hazard Estuarine Shoreline - ORW Shorelineublic Trust Shoreline Other
(Per eider'use only)
GENERAL INFORMATION IbIV)
LAND OWNER-MAILING ADDRESS
Name 0-eN . .A t S t�IJ�.._ PR 5e ,11E
Address F—r
City L�.(t/„), C)�f� __. ... State tJ C- Zi) D-Jij/ Phone 3 ).69`: a i ac
Email l Q L Q G-a‘
AUTHORIZED AGENT {
Deanne lY � 1C (\, � gal1�✓G _"
Address -
City State Zip, 1QQ.Phone Lac)) "' a
Ernail_YYl oku_t cC7Li1'\,Q5 C )( Z-ri
LOCATION OF PROJECT:(Address,street name and/or directions to site;name of the adjacent waterbody.)
c-> 1> - ►rrTttz-A Cvs 1'a W acre-a acre-aw A`i OFF
CG DA (2. 101 t4c'
DESCRIPTION OF PROJECT:(List all proposed construction and land disturbance.) P+e,.(rV) IT( V("i
S-rl2 tA.c1 v1 (camp Ca.bt_r)
SIZE OF LOT/PARCEL:,= fi(j, 1% square feet 7 1 5 acres
PROPOSED USE: Residential ❑ (Single-family❑ Multi-family ❑ ) Commercial/Industrial❑ Other
COMPLETE EITHER(1)OR(2)BELOW(Contact your Local Permit Officer ifyou are not sure which AEC applies
to your property):
(I) OCEAN HAZARD AECs: TOTAL FLOOR AREA OF PROPOSED STRUCTURE: t)(,) square feet(includes
air conditioned living space,parking elevated above ground level,non-conditioned space elevated above ground level but
excluding non-load-bearing attic space)
(2) COASTAL SHORELINE AECs: SIZE OF BUILDING FOOTPRINT AND OTHER IMPERVIOUS OR BUILT
UPON SURFACES: square feet(includes the area of the foundation 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 STORM WATER MANAGEMENT PERMIT: Is the project located in an area subject to a State
Stormwater Management Permit issued by the NC Division of Energy,Mineral and Lund Resources(DEMLR)?
YES NO -
Ifyes, list the total built upon area/impervious surface allowed for your lot or parcel square feet.
-SY ACC() ( A)Q is CA(1l A P MX ?QJ 3 is CT W t l.•1.... NQ i ( E r t /Zt
?) ELvyv, oR S o(2.wn ware( - PEa.rr 'Ti

OTHER PERMITS MAY BC 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:
1,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)
Ian owner or record title,Title is vested in name of O t. Y' \SL-t\i> 1" Q_. s€IZ-V (r (
see Deed Book 1 5`7 -3 page 431 in the CA2 t1 e"J2 ET County Registry of Deeds.
1 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 RIPARIAN 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)
-3& NO 1J`SI\U- -1-- P, `''`&4?—T V (C/ IVER-��{(yiS �f'{ -DPPE121-f .iy�s.y/J 14_,1
(2) 1 i I AJJb 4✓ .1 �.fY+v/ �[�^. �..... 1 / Yam^ ' { ('��. P1-I f { �R r--..
(3) (50OfRS _. t. ........._0.4.f fkL' Ptd#3U C- ARZ `ESL. NCB f1F-1 GA I
ACKNOWLEDGEMENTS:
r I,the undersigned,acknowledge that the land owner is aware that the proposed development is planned for an area which
g g p P l�
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 iot.This explanation was accompanied by recommendations concerning stabiliza-
tion and fioodproofing techniques.
I furthermore certify that I am authorized to grant,and do in fact grant,permission to Division of Coastal Management star`;,
the Local Permit Officer and their agents to enter on the aforementioned lands in connection with evaluating information
related to this permit application. r�
This the a 0 day of Oct, ,20 1 1
i\sl\MJC- — et•I't
Landowner or person authotized to act as his/her agent for purpose of filing a CAMA permit application
This application includes.general information(this form), a site drawing as described on the back of this application, the
ownership statement, the Ocean Hazard AEC Notice here necessary; a check for$100.00 made payable to the locality, and
any information as may be provided orally by the applicant. The details of the application as described by these sources are
incorporated without reference in any permit which may be issued.Deviation from these details will constitute a violation of
any permit.Any person developing in an AEC without permit is subject to civil, criminal and administrative action.

NOtICE
LAMA PERMIT
APPLIED FOR
PROJECT: et,11Scp l�UC�G� `� I tYY1'��U.I�- 4fl,trAffi ,�,rC.LLIY�a
Ln
COMMENTS ACCEPTED THROUGH CW 'JL( '21QLifl
APPLICANT: FOR MORE DETAILS CONTACT
TH LOCAL PF�RMIT OFFICER BELOW:
MAC,4e1 �i: s �I�rs 0 �5
��2 S Pain5tr�.�.�- 25 - 2 Z- F-5 33

PLANNING & INSPECTIONS DEPARTMENT
CARTERET COUNTY,NORTH CAROLINA
DATE: !0 1 (l6) i 7 > Show property lines with dimensions
> Show proposed structure with approximate dimensions
PIN: 53 14 l It 4 Da L ln©©0 > Show any other existing structures on property
> Label distance to all property lines from proposed structure
APPLICANT: Jniv s CSLAND Pa ev (LC' )> Label road,front, rear, and sides
DRAW PLOT PLAN BELOW
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