05-61_Lovelace, Samuel_20050628

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LAND OWNER
Name- )U
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AUTHORIZED AGENT
If Name 11hirrM
Address P. Y 2
City bi S U w
State Zip
State
Phone
Phone
LOCATION OF PROJECT: (Address, street name di Gtions to site. If not ocean
If the adjacent waterbody?) 3 3 U 3 06 eC(14 E
r
DESCRIPTION OF PROJE , ' tall p osed nstruction and I d disturbance.),
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SIZE OF LOT/PARCEL: l d
PROPOSED USE: Reside`7ial /%le -
Other
N1 TOTAL ENCLOSED FLOOR AREA OF A
H. RONMENTAL CONCERN (AEC):
UU I - - L.wvJ
what is the name of
square feet' acres
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family Multi -family 4" ) Commerical/Industrial
F.-
LJ.
G IN THE OCEAN HAZARD AREA OF ENVI-
square feet (includes all floors and roof -covered decks)
SIZE OF BUILDING FOOTPRINT AND OTHER IMPERVIOUS OR BUILT -UPON SURFACES IN
THE COASTAL SHORELINE AREA OF ENVIRONMENTAL CONCERN (AEC): 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.)
Choose the AEC area that applies to your property:
(1) within 75 feet of Normal High Water for the Estuarine Shoreline AEC
(2) within 575 feet of Normal High Water for the Estuarine Shoreline AEC, adjacent to Outstanding
Resource Waters
(3) within 30 feet of the Public Trust Shoreline AEC
(Contact your Local Nmit 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 Stormwater Man ement Permit issued by the N.C. Division of Water Quality?
YES NO
I
If yes, list the total built -upon area/impervious surface allowed for your lot or parcel. square feet.
A

OTHER PERMITS MAY BE REQUIRED: The activity you are planning may require permits other than the CAMA minor
development 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
with your LPO to determine if any of these apply to your project: Zoning, Drinking Water Well, SepticTank (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 ParkApproval, Highway, Connection, and others.
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)
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�an owner or record title. Title is vested in Z_0aj l Z N +CK S , see Deed Book ID S
page e7 q in the _�C r �t°� County Registry of Deeds.
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 and attach to this application.
NOTIFICATION OF ADJACENT 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.
(1)
(2)
(3)
(4)
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FOR DEVELOPERS IN OCEAN HAZARD AND ESTUARINE HAZARD AREAS:
I 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 particular hazard problems associ-
ated with this lot. This explanation was accompanied by recommendations concerning stabilization and floodproofing tech-
niques.
PERMISSION TO ENTER ON LAND:
I furthermore certify that I am authorized to grant and do. in fact grant permission to the local permit officer and his agents to
enter on the aforementioned lands in connection with evaluating information related to this permit application.
This application includes: general information (this form), a site drawing as described on the back of this application, the
ownership statement, 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
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. ,
T is the LA day of ��-- , 20
S
r
Landowner or person authorized to act as his agent for purpose of filing a CAMA permit application.

91
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Acyliduess: OCE--AN Df-"� 3303
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Appficant: Ll' DVELACE-- SAMUEL
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Flage: .1
Datll:,: 8/2J05
Status:
Pl--lsseml? Re.-insgoeir.,tion Required?
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Required Steps: SITE VISIT - PLACE (' ARD - ETC.
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