Maxwell, James

/
aNERAL
MA REDGE &FILL PERMIT Previous permit#
❑New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environment and Natural Resources -71 /� `o �,.} j /
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC 1 f V
_ „,� ,���• -pRules attached.
ppUcant Nll-ame' m !"b�' ii c m. MA�,1 Project Location: County �`e� ~I y <-��
Affected u cW ,; J EW -tJ PTA k4p5 u PTs
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS: ❑FQ
ORW: yes /( no ) PNA yes /� Crit.Hab. yes / no
Type of Project/ Activityi r f
Pier ( -
Platf
Fing,
Groi
A
Basii
Boat
Boat
Bea(
Oth,
Shor
SAV:
Sand
Mo
�Phot
Wai
Street Address/ State Road/ Lot #(s)
n
Subdivision
City 1`/ 0 f i_a>; fGr../ ZIP
Phone # River Basin �i�, It
Adj. Wtr. Body iJ= �rA offI'✓'�r� J`�"P"•' (nat, main /unkn)
Closest Maj. Wtr. Body 01 r' S c' c,r 1;
(Scale:,/ I� )
M—
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.
'prao length 3
-'�istance offshore
.19
i
IN
max distance offshore L
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A building permit may be required by: L G ( r"r�-'� ❑ See note on back regarding River Basin rules.
Notes/ Special Conditions G el f n ri �. _.a t r: (; f r r �� (-� c �rf tr rr ✓ fi

Statement of Compliance and Consistency
This permit is subject to compliance with this application, site drawing and attached general and specific conditions. Any
violation of these terms may subject the permittee to a fine or criminal or civil action; and may cause the permit to become
null and void.
This permit must be on the project site and accessible to the permit officer when the project is inspected for compliance. The
applicant certifies by signing this permit that I) prior to undertaking any activities authorized by this permit, the applicant will
confer with appropriate local authorities to confirm that this project is consistent with the local land use plan and all local
ordinances, and 2) a written statement or certified mail return receipt has been obtained from the adjacent riparian
landowner(s) .
The State of North Carolina and the Division of Coastal Management, in issuing this permit under the best available
information and belief, certifythat this project is consistent with the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
F]Tar- Pamlico River Basin Buffer Rules 0 Other:
Neuse River Basin Buffer Rules
If indicated on front of permit, your project is subject to the Environmental Management Commission's Buffer Rules for the
River Basin checked above due to its location within that River Basin. These buffer rules are enforced by the NC Division of
Water Quality. Contact the Division of Water Quality at the Washington Regional Office (252-946-6481) or the Wilmington
Regional Office (910-796-7215) for more information on howto comply with these buffer rules.
Division of Coastal Management Offices
Raleigh Office
Morehead City Headquarters
Mailing Address:
400'Commerce Ave
1638 Mail Service Center
Morehead City, NC 28557
Raleigh, NC 27699-1638
252-808-2808/ 1-888ARCOAST
Location:
Fax: [phone]
2728 Capital Blvd.
(Serves: Carteret, Craven, Onslow -above
Raleigh, NC 27604
New River Inlet- and Pamlico Counties)
919-733-2293
Fax: [phone]
Elizabeth City District
1367 U.S. 17 South
Elizabeth City, NC 27909
252-264-3901
Fax:[phone]
(Serves: Camden, Chowan, Currituck,
Dare, Gates, Pasquotank and Perquimans
Counties)
Washington District
943 Washington Square Mall
Washington, NC 27889
252-946-6481
Fax: [phone]
(Serves: Beaufort, Bertie, Hertford, Hyde,
Tyrrell and Washington Counties)
Wilmington District
127 Cardinal Drive Ext.
Wilmington, NC 28405-3845
910-796-7215
Fax:[phone]
(Serves: Brunswick, New Hanover,
Onslow -below New River Inlet- and
Pender Counties)
Revised 08/09/06

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04/02/2014 12:01 9192325392 CARY ORTHOPAEDICS PAGE 02/02
ADJACENT RIPARIAN PROPERTY 01NNER STAIEMEftT
I hereby ce*tify that I own property adjacent. to _, }f; ; L, t1'l px�r .Q
r� ?i.� tit , .� (N*mo of Property Owner) --
propeaty tQCated ®t � / i ..{. ,n/GI 1 i. a� �lLc
tAaaress. t.pt, Block, Road, etc,)
ott IJEE b �'��/t�l? in �,X' le-, . N.C,
(Waterbody) (CltylTown andtor County)
The'applicant has desalbed to me. as shown below, the development proposed at the above
40cation.
- I hove no objection Z this proposal.
• I have objections. to this proposal.
DE3CktPT10At ANDIOR ORAUNG OF PROPOSED 1DEVELOPNIENT
OncOvidual ptopasing development must fill rn description below or attain a site draw►h7g)
Bulkhead Repair/Replacement
RECEIVED
APR 0 .1
DCM MUD CITY
MLV &MCTION
I understand that u pier; dock, mooring pilings, breakwater, borathou50, lift. or groin must -be set
back. a minimum distanoe of 15' from my area of riparian access unless waived by me. (If you
wish to waive the setback, you must initial the appropriale blank -Wow,)
'I do wish to waive the 15' setback requir nt:
X I do not wish to waive the 15' setback requirement.
(Property Ovrner Informations)
.Sr�rnrlrrrr
Prfnt or Type fVetme
Af ift Addn9.as
QW.telli z(r?
7e1* one Numbor
r"r.
Irtiorrnation)
William Andersen
Rine or Type pe Nanv
10231 Governors Dr
MaAnq Address
_ Chapel Hill, NC 27517
Ci1y/Sta'&70 919-649-2929
i eleohnrre Number
4-1-2014
[MI
&"ksed 611Mf2)

N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date
/-7 11
Name of Property Owner Applying for Permit:
Mailing Address:`
/dcKe1--y
6oc....:
I certify that I have authorized (agent) Cq- — to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits nec ssary to
install or construct (activity) ' L-t--
at (my property located at) lAAt) SE-Z L--`
This certification is valid thru (date) r
Property Owner Signature
Date

N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date
t
Name of Property Owner Applying for Permit: ivvy
Ay "X2
Mailing Address:
16 e^ 6
I certify that I have authorized (agent){ i tCK�S to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity)
at (my property located at)
This certification is valid thru (date) I(Lt—
I
Property Owner Signature
Date
;L5L-AAA:>.
A/,C.