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HomeMy WebLinkAbout63-17 Hill, Craig 4- Localityla AQOf4IQÜezunruPermit Number Lti 4D'. Ocean Hazard Estuarine Shoreline ✓ ORW Shoreline Public Trust Shoreline Other (For official use only) GENERAL INFORMATION LAND OWNER-MAILING ADDRESS Name /9..li & C 174/ // Address //S 7;1' /) c e' lc. e City C'e Q 4,,,r% State C Zip sr9s-o Phone .2 ` 5-4 e) - e29 Email `— AUTHORIZED AGENT Naive +. _ Address City State Zip Phone Email LOCATION OF PROJECT: (Address, street name and/or directions to site; name of the adjacent waterbody.) A ?.?hi e ja 6 / fl ee1f/v h a,•...,; Ili. r . K f Pi //c / ©ez dt r/ W �f�' 6 / /" DESCRIPTION OF PROJECT: (List all proposed construction and land disturbance.) 0 G e/ .� , 4-.r 4 Fr- 405,-,e6,4 <,.,...,,,,,.:,,, (,...? 2 ,7 6 A 7 / c,fr-yi / os a Alpe Pziml 6,,,A SIZE OF LOT/PARCEL: pou square feet acres PROPOSED USE:Residential f (Single-family ❑ Multi-family ❑ ) CommercialfIndustrial ❑ Other 0 COMPLETE EITHER(I)OR(2)BELOW(Contact your Local Permit Officer i<f 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 SHU,REj.INE AECs: SIZE OF BUILDING FOOTPRINT AND OTHER IMPERVIOUS OR BUILT UPON SURFACES:(p�- square feet(includes the area of the foundation of all buildings,driveways, covered decks, concrete or masonry patio tc. that are with' the applicablea,�c.Atta our calculations with he r, ject drawing.) STATE STORMWATE ANAGEMENT PERMIT: Is the projet to ted in an area subject to a State Stormwater Management Permit issued by the NC Division of Energy,Mineral and Land Resources(DEMLR)? YES NO ✓ If yes, list the total built upon area/impervious surface allowed for your lot or parcel: square feet. - w t - trijtAILI i ..-........-.., ,, :.-,..=-.. .„,... ...... .... ...._.... , vAL. ur y n \.: ettA '3% i 11 ( 1 ' I J- , 41 _, ----7:4 1 1 _____:_, ..........- , . I .._ '°.'-i-- 1 i. 1 1,...,:s 1 ....i\-\. 47 i ( / • 't( c) 1 awL . i ; •.•,' - - -- ,/,, //.., --ert 1 i.. . ,---.1 irk , I, ir • 6/8/2017 Cotaier.IGIS Feature Report _,Nit,f„f,,,,,,, 4*. 1" - i'.1 r,!,.'.1 Cacteret2 7 '*4 Printed June OS,2317 See Below for Disclaimer l'"••41,',,,i ., •i-r — ' -71111,41111;47 i --- .., Address Points : -`:''''. 4.'";)14.4' . - ' ' . 7- .._., ,., ,. 4 ' -_ , ,,. , ,, .,,,,,, ... : ce A 0,.'; : . ' .#*' . '' ,...;,-,..., ,,,,: -,,v t • .4. Parcels - Updated 06-01-2017 --'- ./:, \ ' • n. ., i * ° , ••• 1,-4,-' . / ' ' t .: i ,4 ... '1 ' z1.11,1i -t,;,,-,p''',.i t/ .,:-•, \° Centerlines r:'7,:....'-'-i,t.: , ,,t ' - NC Railroad Right of Way ---•<9,:ige. .* .. 4. 109'.. '' ' q .., , County Boundary .. ', . Other County , 71 :•"; ,: -1 ,, i* 'k.:.itrif,,, - t.!!tr,. ' `-- 'e . • .4, t , . 4 all otliervaIL:es› .,,,, • - , - 4 ' * , 1,07_, 4,411:,,,E.7 ,, Cart ' ''' ' •41• i 4 1 IPIUI I c '' ' ..i.' ' --. ' PIN I,tt ( .r". 4 44(i7:: , ' ,,, - , i '17:. l''''' ''' ,,'I' ,# ,, 4-7,,,,•'',,,;.7., Acreage 105 ., ,,-'''' -.. Parcel Dimensions "•Irz, --,-,--,- 'gt)- ,,-, , I Lot Number'":. A g '''•*'. : '' '-' ri ., 1.02 t., .,-- , , ,*44.' 'C'''NY''''Sj';'''''' '"--• •,, 1 .,,,ags - • - ... , ' -1, .,...i. .. , :-, , , = = .... .„ 4,_ = I ... i Lfc,i_i), .,.. ..,'..-- ., ,ovi • .--, ,....,• :' E — . 8479' **4t . .,'•' S 'f.• 3 ,,, ,, , - s?°15 . 1 ;IGO Feet ; u,328. ' • : , ...,......... f he Information displayed by this website is prepared for the inventory of real property found within th's jurisdiction and is compiled from recorded deeds,plats,and other public records and data.Users of this informationa reherebynoumtifieeds no legal thattn reesanfor onestty for mibeniticrre the Information dpubli public primary containedinformation sources should be consulted for verificationsite.of the information contained on this site.Carteret County, ass guaranteer that the data and map services will be available to users without interruption or error.Furthermore,Carteret County may modify or remove map services and access methods at wiil, 1/1 https://carteret.conneetgis.com/DownloadFile.ashx?i=_ags_map31f97a4e281245f5bOle1457314c41bOx.htm&tr-print _,_ADJACENTFvpARIANpROPERWNER STATEMENT I hereby certify that I own property adjacent to e. 717Q/.._ 's po (Lt4yame o Property Owrip9 property located at f ee.--/01 kJ Q,54S51/4/ (Address, Lot, Block, Road, etc.) on is) C , N.C. (Wet body) (City/Town and/or County) The applicant has described to me, as shown below, the development proposed at the above location. I have no objection to this proposal. I have objections to this proposal. DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT (Individual proposing development must fill in description below or attach a site drawing) cx) Loi--ti-Th 0, 15-Pt- (2,v--%c:i C_c-,YThot • y-y-10,11 F b Ltd fz)IrN- 1)N-LsPQA--k1 Oa r c21/2 1r S erf • ( L. -C-6 "kin cit r-1 Ot_4C C.Av-1 {-• _ L Y-1 (-A(1`.6P 4 -)cE. +.11-EP ?.-VEf. ow" WAIVER SECTION I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or groin must be set back a minimum distance of 15' from my area of riparian access unless waived by me. (If you wish to waive the setback, you must initial the appropriate blank below.) I do wish to waive the 15' setback requirement. I do not wish to waive the 15' setback requirement. (Property Owner Information) (Adjacent Property Owner Information) Sixiatre sigr s) hoc V1r\o(c( rr cp-1, iLh Print o e Name Print or Type Name ere Mailing Address V1-tlil-L/ C c2153SSki City/State/Zip City/State/Zip Telephone Number/email address Telephone Number/email address /17,4(120,2 iv ;k1 9, do) Date Date (Revised Aug, 2014) *Valid for one calendar year after signature* • • ' ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to <2--R/976 C /7 // s {N e of Prope y pwner) property located at 3 -3 1 P�1 � b� , ro ,�j� e s f�'f (Address, Lot' BI ck, Road,etc.) on Cla�rq l cJ t IC , in 99 ' ;, �fi169 r�,+r%,.N.C. i(W erbody (City/Town an County) 1 3 The applicant h s described to me, as shown below, the' development proposed at the above location. u C' '-- I have no objection to this proposal.ro osal. I have objections to this proposal. 3 DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT ' yl (Individual proposing development must fill in description below or attach a site drawing) 19 8 ' ... .._ , , .,„ 0 4 r L A 77 e) /4-1 fA'orte4.7-fre . :,: ,,_ ::: „ f dr. 5 f Cielliilli n1 s sfrel ' 3.t .1%:: 4 0,1T few /7 S 7' or11c.1// . 7 7- n/9 11-;. 1 , cn___ „1 :.; Af hr- 7.-,4"d 1- '2 72 /44 / 2 fr,P c 2 7'17 v v -.--7"-->i i ! ,,:i .‘i U..... i"-- 7--‹i‘A.I Ai z, A ""- - .1 , Cyr 14?-' 7. gg cr -I• -e,ti C - WAIVER ECTION t 1 understand that a Pier, ��p' dock, mooring'pilr�s, breakwater, boathouse;lift, or groin must be set back a Minimum distance of 15';from-my,area of riparian access unless waived by me. (If you wish to waive the setback,-you must.initial the appropriate blank below.) .. do wish to waive the 15'setback requirement. • q' , T' X. : I do not wish to waive the 15'setback requirement. 1 Pra rt(� pe" y Owner information ' (Adjacent Property Owne)nfar"matibn) I Signatur c / Sign .-;7. /,� 1 1- fl y / /1/ - :V,C7;Ci/€ Ti ur1 litter j Print or Type Name Print or TypeName , ,,� / 1 :t f t-�iQ1waJ c, --', C , id: . - .1,A) -W7 (fit Mailing Address Mailin i . ass .fz , ),ter. JO, c .;24r f` j.�. .�,f, . � 2.411W Cfty/Stare.,2rp City1Stafe/Zip 1 • ct d-3y1 ofz s/� �o77 Telephone IVum er Tereptnone�?Vuriiber 1, 67 1 j �v//L s . Date / Date / (Revised 08/2012) ' 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) v/an owner or record title,Title is vested in name of .C" AA 2`(, /4/7 see Deed Book (3Cre0 page e. (f in the *CA X ria447j. County Registry of Deeds. an owner by virtue of inheritan .Applicant is an heir to the estate off , (..,, ; -7carl")4'"t‘ •c j 3D42 51'//'• R<r c 3 7 41 3 0,,J 47y/echo;probate was in j.��,o,e,a .1 _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) (1) a ex, e ov4 -,e o.S' Aohe 417 r."-s7 c r'/ r, .,:-7- (2) _ i, 'r F '.2 - 31 it 6 1 r .. (3) (4) . j'1f` V e e a - /-2i �t o.� l4 fir, dic. ACKNOWLEDGEMENTS: I' ' 8r/_ S.4'2 1`� P 3" 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 furthermore certify that I am authorized to grant,and do in fact grant,permission to Division of Coastal Management staff, 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 'r" day of 2"c ,20 e,�.`�� I ,Ar`� ,' -ex S.dower person authorized 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 where 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. Locali , DI OLU12fr —( �- f ry VV'�� l i QAUJ4 ) Permit Number CO lt� Ocean Hazard Estuarine Shoreline ✓ ORW Shoreline Public Trust Shoreline Other (For official use only) GENERAL INFORMATION LAND OWNER - MAILING ADDRESS Name 6- j o� / Address /Ks— /c I"*) A3 ' C`.°f47A City et" e:(,47 ._... d.,v I State A), G Zip agr Phone .2-Cs?_ 4 e - e--?9.-.? Email -- AUTHORIZED AGENT Name ti,.,1t.1� ., Address City State Zip Phone Email LOCATION OF PROJECT: (Address,street name and/or directions to site; name of the adjacent waterbody.) e er4oft e-i,',47 ,t. C v7 Kr s7 /cv / 0,4 t P •e-N) : �,r�' D 4 k DESCRIPTION OF PROJECT: (List all proposed construction and land disturbance.) 0 G r ' r•3 e'�' t 4S, 6 Alf er.,,,oir, /94.,+ SIZE OF LOT/PARCEL: POD square feet acres PROPOSED USE: Residential f (Single-family 0 Multi-family 0 ) Commercial/Industrial 0 Other 0 COMPLETE EITHER(I)OR(2)BELOW(Contact your Local Permit Officer if you are not sure which AEC applies to your property): (I) 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 SHO,REIANE 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 patio tc.that are withi the applicable c.Atta our calculations with he r ject drawing.) +• to /Al 2e r) SA, S' STATE STORMWATE NAGEMENT PERMIT: Is the pro' 10 ted in an area subject to a State' Stormwater Management Permit issued by the NC Division of Energy,Mineral and Land Resources(DEMLR)? YES NO v'' If yes, list the total built upon area/impervious surface allowed for your lot or parcel: square feet. .... r.Jt'Li ) r........_________ _..•• ,. ., ..., „„ ,„...,. .. -_,),_.} 1 ut w I-01r i, ', r ,, , 1 t 1 , , ..„ i )....., 41- ._b 1° --- --,------ J1 /1\ I ' 1:s. i rr 1 1 , / 1 * I '? ,. ‘...?\ I \ i ,,, .. , p-, i 7 I / / : 1 . , . , kr- , i , i , , 1 ( , ,, .,, ( .„talia...,..„------ , Api Alt --,,, „-------- i / I ... ...)) ....... 1 ir . . . .— 6/8/2017 CornectGIS Feature Report Caiteret2 .,,,,,,,i,,i",,,,,, el' - ' ' 'i I ( 1 GIS ,:',0#4.1-4 Vit PoStNC,. iii Printed June 08,2017 See Below for DisclaimerB i ., II , .:.m.i.,,oli 6,- . , .1 'r— 4 Address Points ' ., v'''''‘,11111* * ..„! . ' —' W '-.-- , ,,, ., .' •4 / 71 ---' , 0$ .,, . ffii '''' ''' ' ' ' ' Parcels - Updated 06-01-2017 ' '141.4' ,.:- Centerlines i.- I* i•.. 54;'t.°/ i' ,'-''' V'4.... P 1.• NC Railroad Right of Way 1 II.L...--- - -" ,-1-.. ''::...; ..,.. i lir -',,,' ,. ''''c' ''''',''''i '''' ' %' - :/'''''te• .c. i ...i., ,11 :' 1', :. lA 'V* County Boundary ,. ' 5 '7, ' . '' i .. : ,. .t:•-,1 ri ',',..,,,.. - a: -k..',-.,,.,,, 4 4 1-3 ''' '''• ----- .i. Other County .. (ti '.,:i2 ' -,-,,,,,,:i,l; -1,- ;•-; , --- t, Y1 ,i(--• -* ..,404,12:',' ' '-‘1. *te-I.-1 ' 1•,`'- .t., f : • 'tall OtItervalt-les> frt. C rt PIN ,..:"I'.4- - ' -:-A1 e'''t ';;:ifitat:'' ' Acreage 105. . Parcel Dimensions : - , - ., 1 ,0„ t:-:,'-----, ti „if , , -,,,,,',,- , 1,, .,,•! Lot Number .., _N •/---' 1 i, ...., . ,----V:21 1 /t/1 3 o .-,,„::,, 1, . tV• .--.,. .. “, ' 1 4',,,.,„ 1 - ' (r-f --- _ IA7 , "•,,,,•••', , AI`,.. ,t•-e-„,/-.,_,•1 d;.,...,( -".."'".; "".:'; • • ,; sl '.1LI,„----I-tit ..-------' , . ,.,,,,,'•• ...,M„0 ,,....,:•1-0 i:" 160 fto ' ;, .,..,..---- f '*-). ,.. •''i'..•- 400 ', --- _.,ie.,,,4)., 0 ivst,No-- .7-, -------_ 1,_,L",';'.—,,,,::\ L.1 r e.„. .. _. N ' • 11A, 4\\7':Vi V. ,::;,-;;,'i , . S, .,,it:1'326; , .: *,,: , 8479 • --,:- ; ,, ol•c..t. -,.• . 0515 ' - . 1 .100 Feet 328,7 - •,'1I;'. ' v " . .. :„ • . • The information displayed by this website s ...prepared for the inventory of real property found within this juriscfction and is compiled from recorded deeds,plats,and a information sources should be consulted for other public records and data.Users of this'information are hereby notified that the aforementionedpnbfloicarp verification of the information contained on this site,Carteret County assumes no legal responsibility for the antimonrYcontained on this site.Carteret County does not ant that the data and map services will be available to users without interruption or error.Furthermore,Carteret County may modify or remove map services and gatueearssmeeethods at wig. 1/1 https://carteret.cainectgis.ccm/DownloadFile.ashx?i--_figs_fnap31f97a4e281245f5bOle1457314c4fbOx.htm&t=print QJcENT RIPARIAN PROPER.n, OWNER STATEMENT I hereby certify that I own property adjacent to e. 74zz_ otri_ (Name of Property Owner) property located cF1 0.. QS:45,N (Address, Lot, Block, Road, etc.) on , in N.C. (Wat body) (City/Town and/or County) The applicant has described to me, as shown below, the development proposed at the above location. I have no objection to this proposal. I have objections to this proposal, DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT (Individual proposing development must fill in description below or attach a site drawing) bcoct. t 4DY-1 s ;(1-Q cx) k -C=t- Q-€., k OcLhZreel Ltiirt. S +rnek )(<3 b Ltd oc4 ca-v-“:1 C-0•1-"u'N • tcyk e_rt 1.0 oci r-chalr-s c"-t crf Cox+-le:1k t • ( -c-6, c_g cAv-1 C.-E.1•1-CL 1r- -1Liz. (9 L C Q_ -LY-704' SCA ile6 r1 -4s 1 a kY7 1/4-41icv-E ?xS)* vut` WAlVtR SECTION I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or groin must be set back a minimum distance of 15' from my area of riparian access unless waived by me. (If you wish to waive the setback, you must initial the appropriate blank below.) I do wish to waive the 15'setback requirement. I do not wish to waive the 15' setback requirement. (Property Owner Information) (Adjacent Property Owner Information) Sitniature Sigrirr If) hOC \ICA Print o e Name Print or Type Name /45 tV-1 ere aic C+ M Wng AddreA Mailing Address City/State/Zip City/State/Zip Telephone Number/email address Telephone Number/email address 4/4 rz be aR 9, do/ Date Date* (Revised Aug. 2014) *Valid for one calendar year after signature* ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to .,7`6 . C /7 4 /'s N of Pro e . e py pwner) property located at_ _ k< }l2 ,�, 1 , c 51 �' V (Address Lot Block Road v �� r�' i'?`1+C , in c f i!'�C pa ?PLC. :' . (W erbody (City/Town an or County) . ::-.III The applicant h s described to me, as shown below, the development proposed at the above lotion. I have no objection to this proposal. have objections to this proposal. t DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT; ` -'(Individual proposing development must fill in description below or attach a site drawing) i 19 80 4 r 4. t •/477 e) Ai /A'or e`,7-1)e :. : l, _,r ref{' e5 C /9/ In T dS , '-i. . •'',A 6.44.,A; . .1 / S . T . . , A,5- x' 5' *) : A : IMM r r 7 t/?c. WAIVER :i ._, , , i , „pc„er-ii7trci , ::'1 . ,q/ 6 ), r-: 7.--;le= ''' , ‘1V7 . -- , 4 '4 .1 I :,:jir ke-,r p,i..,.../4,,,, r) ) 0.1,-. (et/ 4i .v 4 ' ''''' 1 t sI�: Ti. I understand,that a"pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set back a Minimum distance of 151.ftom my:area of riparian access unless waived by me. (If you ; wish to waive the Setback, you must:initial the appropriate blank below.) J. do wish to waive the 15'setback requirement. • • . • : X. t I do not wish to waive the 15'setback requirement. (Property Owner lnfortnation (Adjacent Property Owner. nformation) , ''.12-#40,v7) C l . ems' j i..cat- ,tilt-- 1- �Signatur c IR 4 1 a �/ Si,gti % /,/ _ _ i `j Print"or Type Name Print or Type Name , ,,�j 1 . ,3'� ',4w.qJ CACCrE C, /".7 . �/1,A/ f r7ff - J ' aping Address _ Mallin ' •• ess ( `; c r,r .r).t }:,,/ A.), c .2 `fJ , ; /,,7L 41 , 2- .:( 1.- 1City/State/20 1 , 5 , ".:. ._ct 4. .._ d 2f. Citylutai`2ips'z 31 907e Telephone Num el; : Te/ephcniNumbar 6 /(4, 2•./)/r7 474(27 .1 4 Date Date • 1 (Revised 6/18/2012) ` s. 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: 1,the undersigned,an applicant for 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) I An owner or record title,Title is vested in name of /� (, e - /{ see Deed Book (56, o page 6 '� in the , e''/�,,e Tiaie47"0 County Registry of Deeds an owner by virtue of inheritan .Applicant is an heir to the estate of �'!�c"/ ( '~ T> 1JG /4'#'A. a � t 344 81 y/ • �i s 7Y/ D„ play/va,";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) �j (I) 3�"'+ I c.� f l tom' �D 1 e�a j �' d�/it'�' f'S'/ riAtit t' i•''7— (2) C- _ 42.4 feg/ #Ag.2 — 3 / it 76 7 Y — (3) / (4) r tl C'4- /a/00 /A ? >��t 0 r*� 1.0 fi rs J1 0f i ACKNOWLEDGEMENTS: �r 7/4'� 2 r� 8 d.2� ,`6 ,2 Pr kV*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 furthermore certify that I am authorized to grant,and do in fact grant,permission to Division of Coastal Management staff, 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 /1 day of IJ eC- ,20 /7 l do fnergperso a authorized to act as his/her agent for purpose of filing a CAMA permit application This application includes:general information(this farm),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 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.