27-18 Williams, John

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Ocear.Hazard -_.r._ E>;tuarine Shoreline DEW Shoreline _,Public Taut Shoreline Other j
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GENERAL,INvoRMATION
LAND MAY 201
Name 'ALi]L_1_ t.` \C1-V 'fS BY: r
Address 5or15 p t�'>;.i.SC7-v\A- -\ t\ kC ,v }
City C C.C,�,--, .,( 'I�LLJ�Y\� '1 State _ Zip 3'Phone g,J-5.2 , t , rp.cA t :.I
Email Cl e.Y- () (fi �-j 'e.
C�tJ ��vv, , _v�c J d c �7 �1���.t .) ,C rely .__
AUTHORIZED AGENT •"
Name �C e-tc;,.N\f,A Y-\P b C�NE,,kc>1 ' '=, --1
Address Fc' E Ok..J.s.?
City �.1�`�CA—�..�State �(`' Zipf �p,one f �,?5 d�^��,
Email - I ‘ e_a-\IV�k;'e Cw l(Dp:),Y— C.byI-vn
LOCATION OF PROJECT:(Address,street name and/or directions to site.If not oceanfront,what is the name of the
adjacentwaterbody.) ''j,n.6 CorkiCLLSrt xtL 5;,1,t.,� 1.—c-k CA.(L1Y t t'1C
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DESCRIPTION OF PROJECT:(List all proposed construction and land disturbance. .L�4-6.�YL -C.l \ l
k•�� 6l,l.I.' '_Z.�i \ l
SIZE OF LOT/PARCEL:1, --t --square feet acres (_C%.' Gj L.0-V\V
i;
PROPOSED USE:Residential (Single-famllyV Multifamily❑) Commercial/Industrial❑ Other [i ir'—'
COMPLETE EITHER(I)OR(2)BELOW(Contact your Local Permit Officer If you are not sure which AEC applie s
N your properly):
(1) OCEAN HAZARD Ax'-e: r . L i OR A i P'OPOSED'STR -i'' ' "square feet(include':+
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 ABCs:SIZE OF BUILDING FOOTPRINT AND OTHER IMPERVIOUS OR BUIL •_
UPON SURF'ACES3quare feet(includes the area of the roof/drip line eel!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 ..,
Managemey Permit issued by tho NC Division of Water Quality'?
YES NO
If yes,list the total built upon area/impervious surface allowed for your lot or parcel: 7)i t;Drr:)0 square feet.

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'funk(or other sanitary waste r.
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)
\/an owner or record title,Title is vested in Nil lit L,(„) I Book -
inIt+ C
,t Yl��Deed
page (O` the ',,�,t.y y'fs ' ` County Registry of Deeds.
an owner by virtue of inheritance.Applicant is an heir to the estate of ,
probate was in County.
other interest,such as written contract or lease,explain balmy 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.t affirm that I have giv - ,- •
ACTUAL NOTICE to each of them concerning my intent to develop this property and to apply for a CAMA permit.
(Name) (Address) ';
(i) .1evav, yVka_ko,, It '7 3 CrA.v v`\C�v
(2) Cm-< t.1.ti4.)v1G�,- ' c - T c V�NADA An... '✓ �T", e,
(3) — (� C,
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ACKNOWLEDGEMENTS: ,„,;t
I,the undersigned,acknowledge that the land owner is aware that the proposed development is planned for an area which
maybe susceptible to erosion and/or flooding.I acknowledge that the Local Permit Officer has explained to me the partieu „`
lar hazard problems associated with this lot.This explanation was accompanied by recommendations concerning stabilize- ;' ``
tion and floodproofing techniques.
I furthermore certify that I ant authorized to grant,and do in fact grant,permission to Division of Coastal Management staff,i
the Local Permit Officer and their agents to enter on the aforementioned lands in connection with evaluating information
related to this permit application, ft\
This the t �� day of�i\CL9,20 t 0 `'
Landowner or 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.
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