52341_COOPER, A.B._20080708

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❑ CAMA / ❑ DREDGE & FILL �� _ �' 4 1
r. GENERAL 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 Res rrces
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
El Rules attached.
Applicant Name
Address
City State -- ZIP )
Phone # () Fax # ( )
Authorized Agent
Affected
❑ CW ❑ EW ❑ PTA
AEC(s):
❑ OEA ❑ HHF ❑ IH
❑ PWS: ❑FC:
ORW:
yes / no PNA yes / no
❑ ES I 1 PTS
❑ UBA ❑ N/A
Crit.Hab. yes / no
Project Location: County
Street Address/ State Road/ Lot #(s)
Subdivision
City ZIP
Phone # O River Basin
Adj. Wtr. Body (nat /man /unkn)
Closest Maj. Wtr. Body
........................................
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Agent or Applicant Printed Name PermitOfficer's Signature
Signature ** Please read compliance statement on back of permit ** Issuing Date
Expiration Date
Application Fee(s)
Check #
Local Planning Jurisdiction
Rover File Name

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 1) 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
Iandowner(s) .
The State of North Carolina and the Division of Coastal Management, in issuing this permit under the best available
information and belief, certify that this project is consistent with the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
❑ Tar - Pamlico River Basin Buffer Rules ❑ 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 (252-946-648 I) or the Wilmington
Regional Office (910-796-7215) for more information on how to 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/ 1-888-4RCOAST
Location: Fax: [phone]
2728 Capital Blvd.
Raleigh, NC 27604
919-733-2293
Fax:[phone]
(Serves: Carteret, Craven, Onslow -above
New River Inlet- and Pamlico Counties)
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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A r
PROPERTY OWNER STSTEMENT
Hereby certify that I own /or have a6thorization to sign for the property at
O�-
Lessee Fdd i e �P M" ti -4 has described to me, as shown
below the development he isosing at that location, and I have no objections to his
proposal.
I authorize Thomas Lawrence to act as agent to obtain all necessary permits to
perform this work.
DESCRIPTION A*ND DR�A''W// ING /OF, PROPOSED DEVELOPMENT:
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I �1. E-- lot -�
jq
1'-\ . '!> • �
Print name or type
j� 4: a- 7a(9
Telephone number
":-ate-vR
Date
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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSIBOATLIFT/BOATHOUSE)
(Lcfaee
I hereby certify that I own property adjacent to006014- &11z�
C�,,�.✓:.mod
(Name of Property Owner)
property located at � D IV.,--%/ � h O t- e � t' ,
(Lot, Block, Road, etc.)
on 6 a U &�in wee I�1 C.
( aterbody) (Town and/or Cou(Y)
He has described to me, as shown below, the development he is proposing at that location,
and, I have no objections to his proposal. I understand that a pier/mooring p ings/boatlift/boathouse
must be set back a minimum distance of fifteen feet (15') from my area oriparian access unless
waived by me.
I do not wish to waive the setback requirement.
I do wish to waive that setback requirement. .
-------------------------------------------------------------------.. _.. , .----------------------------------
DESCRIPTION AND/OR DRAWING OF PR P SED DEVELOPMENT:
(To be filled in by individual proposi development)
I A �o
-----------------------------
(Applicant Information)
/'-�U 1V or4-t Sk.r-r- if
Mailing Address
City/State/Zip / Z.
,�.sD k/3 -3
Telephone Number
_ It , o%-,
Date
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.-------------------------------------------------------
(Riparian Property Owner Information)
Signature
Print or Type Name
y s"z-? z 3' ?'l9 g
Telephone Number
&-2G',,Y
Date

, ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSIBOATLIFT/BOATHOUSE)
I hereby certify that I own property adjacent to
(Name of Property Owner)
property located at /a D o t- e f
(Lot, Block, Road, etc.)
on d 4Q 14�r�,. �,.. , in 41P N C.
( aterbody) (Town and/or Cou )
He has described to me, as shown below, the development he is proposing at that location,
and, I have no objections to his proposal. I understand that a pier/mooring pilings/boatlift/boathouse
must be set back a minimum distance of fifteen feet (15') from my area of riparian access unless
waived by me.
I do not wish to waive the setback requirement,
I do wish to waive that setback requirement
1
-------------------------------------------------------- ---- ----- ' ---------------------------------------
DESCRIPTION AND/OR DRAWINCx OF R POSED DEVELOPMENT:
(To be filled in by individual pro s g development)
-�'e-y �AC\e
(Applicant Information)
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Mailing Address
City/State/Zip Z
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Telephone Number
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(Riparian Property Owner Information)
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Signature U
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Print or Type Name
Telephone Number
'C"a�;
Date
Date

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to .� 's
(Name of Property Owner)
property located at AA 0 /" ar-, �i C)-" & ,
(Lot, Block, Road, etc.)
on , in e�G C.
( aterbody) (Town and/or Coun )
He has described to me as shown below, the development he is proposing at that location,
and, I have no objections to his proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(To be filled in by individual proposing development)
1' v- 6
(Applicant Information)
Mailing Address
City/State/Zip l�
Telephone Number
Date
(10
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--------------------------
/ (Riparian Property Owner Information)
Sigjn/ature
Print or Type Name
Telephone Number
3 �ov
Date

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent tois
(Name of Property Owner)
property located at �� o
(Lot, Block, Road, etc.)
on a .e ca-ww,. , in 3--re"
1&r .C.
aterbody) (Town and/or Coun )
He has described to me as shown below, the development he is proposing at that location,
and, I have no objections to his proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(To be filled in by individual proposing development)
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(Applicant Information)
Mailing Address
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City/State/Zip
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Telephone Number
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Date 0/// /'/')Y
(Riparian Property Owner Information)
Signature V
Print or Type Name
Telephone Number
Date

ISLAND MARINE CONSTRUCTION LLC 2600
1286 ISLAND RD
HARKERS ISLAND, NC 28531 66-21/530
PHONE: [phone] BRANCH 77513
DATE
PAY TO TH E
ORDER OF
ma WACHOvIA
Wachovia Funk, N.A. /�
(w'a�G—iov�ia.com gyp`
FOR / ...0 3/ ftiJ
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$ o24D . ).-)
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