65071D - Maxwell

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'ENERAL PERMIT Previous permit#
New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
•ized by the State of North Carolina, Department of Environment and Natural Resources
:oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC 0 7 AIO�J
❑ R lds attached.
t Name M{►.'l<W1A - 1600 '- ,4-- Project Location: County A)
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4992:!j t3;"OA-D State NG ZIP Z 7 `� 3L
Oft)) Z16 -q04 ! Fax # ( )
ed Agent I 4
❑ CW HEW ` }PTA VES ❑ PTS
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS: ❑ FQ
yes f no PNA yes no Cri1t.Hab. yes ' no
Project/ Activity
A) length
Xz
er(s)
igth
nber
I/Aiprap lengA
distance offshore
K distance offshore Q.
annel
,ic yards
ip
oatlift ) %O
illdo g
Length
not sure yes
not sure yes
um: n/a yes
yes
,ttached: no
Street Address/ State Road/ Lot #(s)
1�ocz 5%Xf4 9.
Subdivision
City `:7 ZIP
Phone # ( `'r' River Basin
Adj. Wtr. Bod zfl Ll SUIIt
Closest Maj. Wtr. Body
/, r /+
tale: I(( Z
ig permit may be required by: ��/" ❑ See note on back regarding River Basin rL

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Date Check Check
Received Check From (Name) Name of Permit Holder Vendor Number amount Permit Number/C
12/10/2014 Sun Technologies Sandeep Sharma B of A 5073 $436.00 Vio#14-11 D
12/11/2014 Boatzright Inc. Kevin Thomas First Citizens Bank 1805 $200.00 GP 65069D
12/11/2014 Holden Dock & Bulkheads Don & Elizabeth Whitener First Community Bank 5955i $200.00 GP 64061 D
12/11/2014 S&ME USS North Carolina B of A 4728 $400.00 major fee, Wilmingt
12/12/2014 Riptide Builders, LLC same, owner Donald Bean BB&T 7525 $50.00 minor exemption fe,
12/12/2014 Holden Dock & Bulkheads Dodson, Baxter, Mauney--- First Community Bank — 5958 $600 00 GP 64087D, 640881
12%12/2014 Charles and Carol Walters Gloria G. Smith BB&T 7988 $200.00 GP 64085D
12115/2014iDavid Davis, Steven Davis, Janice Baldwin David Davis SunTrust 1596 $100 00 minor fee, 1203 Oo
12/15/2014 The Village of Bald Head Island same PNC Bank 57246 $100,00 renewal fee, MP 22
12/17/2014 Stewart Engineering, Inc. Sea View Properties PNC Bank 12179 $200.00 fees for mod & rene
12/17/2014 Connaway Marine Construction, Inc David Wilson and Martin Covert B of A 6895 $200 00 GP 52465D
12/17/2014 Oak !stand Accommodations Jay Motzinger BUT 32781 $100.00 minor fee, 703 Casi
12/19/2014 Lighthouse Marine Construction inc Maxwell Foods LLC B of A 5194 $600.00 GP 65071 D
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NC 'Dlvlsion of Coastal Mgt, Habitat Impact Computer Sheet
4pplicant: �x '�i j� �-bo�� v - Permit #:
Date: 12 r r G) I
)escribe below the HABITAT disturbances for the application. All values should match the name, and units of measuremen
ound in your Habitat code sheet.
iabitat Name
DISTURB TYPE
Choose One
TOTAL Sq. Ft.
(Applied for.
Disturbance total
includes any
anticipated
restoration or
temp impacts)
FINAL Sq. Ft.
(Anticipated final
disturbance.
Excludes any
restoration
and/or temp
impact amount)
TOTAL Feet
(Applied for.
Disturbance
total includes
any anticipated
restoration or
temp impacts)
FINAL Feet
(Anticipated fins
disturbance.
Excludes any
restoration and/
temp impact
amount)
Dredge ❑ Fill ❑ Both ❑ Other
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑

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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to At f « I- i9r0kA(f s
(Name of Property Owner)
property located at 40 5-0ta'`t` ,S�
(Address, Lot, Block Road, etc.)
on , in Scar � C,*y N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
1 have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
1 A s L . (individual proposing development must fill in description below or attach a site -drawing)
r`p�r- :1 j �ei(OG�G @.?(YeYtSi0Y1
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WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or groin
most be set back a minimum distance of 15' from my area of riparian access unless waived by
me. (If yoa--wish to waive the setback, you must initial the appropriate blank below.)
it I do wish to waive the 15' setback requirement.
I do not wish to waive the 15` setback requirement.
(Property Owner information)
1_&U.� oC . �J
Signature
Alice. L. $rowN
Print or Type Name
P. o •t0oK a47
Maili Address
f�enans T (Ie uc at 3 qq
(Adjacent Property Owner Information)
Signature *
Print or Type Name
Mailing Address
Pore

ADJACENT RIRARIAN PROPERTY gMNER STATEMENT
t MA's 4- • tom? t4, Yr .
I hereby certify that I own property adjacent to C Por Er t C,�, 's
property located at 6 051 (d,` k S4-. (game of Property Owner)
(Address, Lot, Block, Road, etc )
on , in 5urr
(Waterbody) N.C.
(City wn atndlor C®unit')
The applicant has described to me, as shown below, the development proposed at the above
I have no objection to this proposal.
i have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must till in description below or attach a site drawing)
L Y1Gv�n nE.. J � (�oC�G f.1f 'T?Tl $Otrj
oW rie�s T i 1
a�ic 484g, �S,dock exknsi�s_� ! I {
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f i�.iin 5 Jrar
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1�ijQ
WAIVER SECTION l
I understand that a pier, dock, mooring pi!ings, boat ramp, breakwater, boathouse, lift, or groin
mast be set back a minimum distance of 15' from my area of riparian access unless waived by
me. (If yofr wish to waive the setback, you must inMW 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)
Signature
Stgnazure
Thomeas L. �r=ee xY �
Chra.Io }}e pe, c�
Pnnt or Type Name
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Pt ltTt or Type /Vamp ""—
Ott
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Mat i g Address
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