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Home My WebLink About71873d - Dill Locality Permit Number Ocean Hazard Estuarine Shoreline ORW Shoreline Public Trust Shoreline Other (For official use only) GENERAL INFORMATION LAND OWNER��,MAILING ADDRESS Name A&—AI� J :;,,) 2 t' b I Address f� City Email ` r AUTHORIZED AGENT Name Address City Email State (V (_— Zip !Q ��hone State Zip Phone 70N-3&I-/3EO LOCATION OF PROJECT: (Address, street name and/or directions to site: name of the adjacent waterbody.) t-)1 S1 / � -f l �"VlO,t . Sur,( 6 �lJ /V & C}ahQ J DESCRIPTION OF PROJECT: (List all proposed construction and land disturbance.) i rn 40-1/ / b, oyo l6 boa4 l� T SIZE OF LOT/PARCEL: square feet ` ' ti acres PROPOSED USE: Residential �L (Single-family ❑ Multi -family ❑ ) Commercial/Industrial ❑ Other COMPLETE EITHER (1) OR (2) BELOW (Contact your Local Permit Officer if 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 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 STORMWATER MANAGEMENT PERMIT: Is the project located in an area subject to a State Stormwater Mana ement Permit issued by the NC Division of Energy, Mineral and Land Resources (DEMLR)? YES_ Noy If yes, list the total built upon area/impervious surface allowed for your lot or parcel: square feet. OTHER PERMITS MAY BE REQUIRED: The activity you are planning may requ minor development permit, including, but not limited to: Drinking Water Well, Septic treatment system), Building, Electrical, Plumbing, Heating and Air Conditioning, Inst Certification, Sand Dune, Sediment Control, Subdivision Approval, Mobile Home Pal 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 person authorized to act as an agent for purposes of applying for a CAMA minor devc listed as landowner on this application has a significant interest in the real property de described as: (check one) Y an owner or record title, Title is vested in name of � j �� see Deed Book ? 1r page �{'l1 1 in the j%T-7Tn"' _an owner by virtue of inheritance. Applicant is an heir to the estate of ; probate was in if other interest, such as written contract or lease, explain below or use a separat NOTIFICATION OF ADJACENT RIPARIAN PROPERTY OWNERS: I furthermore certify that the following persons are owners of properties adjoining th ACTUAL NOTICE to each of them concerning my intent to develop this property a (Name) (Address) (Address) (� (1) leN1l(A I-itit(rS� o l0 (2) o (3) (4) ACKNOWLEDGEMENTS: 1, the undersigned, acknowledge that the land owner is aware that the proposed deve may be susceptible to erosion and/or flooding. I acknowledge that the Local Permit ( [at hazard problems associated with this lot. This explanation was accompanied by r tion and floodproofing techniques. I furthermore certify that I am authorized to grant, and do in fact grant, permission a the Local Permit Officer and their agents to enter on the aforementioned lands in cot related to this permit application. ) (� This the Landowner rio,er;onYuthorizcd to act as his/her agent for purpose of filing a CAM. includes: general information (this form), a site drawing as descri ownership statement, the Ocean Hazard AEC Notice where necessary, a check for S any information as may be provided orally by the applicant. The details of the appli incorporated without reference in any permit which may be issued. Deviation from t any permit. Any person developing in an AEC without permit is subject to civil, crin ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to s (Name of Property Owner) property located at � d `� ��t"2.�{- (Address, Lot, Block, R ad, etc.) on C(i,,._ �� , in N.C. (Waterbody) (City/T-6wn 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) b�- WAIVER SECTION I understand th t a pier, doca,molring pilings, boat ramp, breakwater, boathouse, lift, or groin must be set bac 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) Si ature toy Print or Type Name (Adjacent Property Owner Information) - Lda Signat r, Print or Type Name ADJACENT RIPARIAN PROPERTY OWNER STATEMENT • I hereby certify that I own property adjacent tom";?, - 61�� L-O-UAR, 0, s (Name of Property Owner) property located at I 0 I j s-t St UR� Cl' � [A M / --N �1 I I e- (Address, Lot, Bloc*, Road, etc.) I ` on C (�- , in � L ►'� N � , N.C. (Waterbody) (City/To n 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 mkt fill in descr4Vion below or attach a site drawing) N� DILL t--+ PT I �Y SO KT RMM Q WAIVER SECTION I understand that a pier, dock, mooring pilings, 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) . Q Signature S nature %� 2 . b; i ) Print or Type Name Print or Type Name ,-?76s •��- AA-;I;-- A.4,4-- .. RECEIVED t'l� -- " VL,'� Check Check White Kehaya Bank of America 2424 $ 400.00 GP 976472D KE rct. 10765 ust Tsame Fidelity 1022 $ 400.00 GP #765 9D BB rct, 11532 David Buffs BB&T 10146 $ 200.00 GP #76464D BB rct. 11527 GP #76518D (one check written for $800 split between two Ga and Martha BB&T _ 7461 $ 400.00 permits)_ BB rct. 11531 GP #76517D (one check written for $800 split between two d Martha Pope Gar and BB&T 7461$ 400.00 ;permits BB rct. 11531 lson/Richardson Cc James McMillan BB&T 7757 $ 200.00 GP #76462D BB rct. 11530 > II same Aquesta Bank 1593 $ 200.00 GP #76468D BB rct. 11529 > II Judy Garst Aquesta Bank 1592 $ 200.00 GP #76549D BB rct. 11528 buction, LLC Shepard Broadfoot CresCom Bank 3201 $ Z00.00 GP #76463D BB ret. 11534 on, LLC Daniel Clements FCB 269 $ 200.00 GP #76560D JD rct. 10821 Nathan Faulkner BB&T 88351 $ 200.00 GP #76559D JD rct 10820 onstruction Co. Diane and Dave Rodgers South State Bank 11849 $ 200.00 GP 06470D KE rct 10783 iy same BB&T 6495 $ 200.00 GP #76586D JD rct. 10819