57125_COOPER, A B_20110225

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CAMA ID DREDGE & FILL
f' GtNERAL PERMIT
❑New []Modification ❑Complete Reissue ❑Partial Reissue
As authorized by the State of North Carolina, Department of Environment and Natural Resources
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC_
Applicant Name
Address
City
State ZIP
Phone # (` }
Fax # ( )
Authorized Agent
El CW
❑ EW ❑ PTA ❑ ES ❑ PTS
Affected
AEC(s): O OEA
❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS:
❑ FC:
ORW: yes / no PNA yes / no Crit.Hab. yes / no
Previous permit #
Date previous permit issued
Rules attached.
Project Location: County
Street Address/ State Road/ Lot #(s)
Subdivision
City ZIP
Phone # ( ) River Basin
Adj. Wtr. Body (nat /man /unkn)
Closest Maj. Wtr. Body
Type of Project/ Activity
Pier (dock) length
(Scale:
!
Platform(s)
Finger pier(s)
Groin length
number
Bulkhead/ Ripraplength
avg distance offshore
max distance offshore
Basin, channel
cubic yards _
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
-TIT
.45
i'
Shoreline Length
SAV: not sure yes no
t
Sandbags: not sure yes no
Moratorium: n/a yes no
Photos: yes no
Waiver Attached: yes no
A building permit may be required by:
Notes/ Special Conditions
❑ See note on back regarding River Basin rules.
Agent or Applicant Printed Name
Signature ** Please read compliance statement on back of permit **
Permit Officer's Signature 1
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
landowner(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 (252-946-6481) 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
Mailing Address:
1638 Mail Service Center
Raleigh, NC 27699-1638
Location:
2728 Capital Blvd.
Raleigh, NC 27604
919-733-2293
Fax:[phone]
Morehead City Headquarters
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/ 1-888-4RCOAST
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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AoF licant:
r
Date: 1 t j
Lq tv uw
Describe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
found in your Habitat code sheet.
Habitat 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
ternim acts)amount
FINAL Feet
(Anticipated final
disturbance.
Excludes any
restoration and/or
temp impact
#redge 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 Cl
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
0
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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSBOAATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to A\KC --k,p" , L— 's
(Name of Property Owner)
property located at r Iq
(Lot, Block, Road, etc.)
on C— .4 in A4L-.An r4 e L egEwe .- , N.C.
(Waterbody) (Town and/or County)
Applicant's. phone: # —7Z� Z�S Mailing Address.: %�
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. (If you wish to waive the setback, you must initial the appropriate blank
below.)
I do not wish to waive
1 do wish to waive that setback requirement.
DESCRIPTION ANDfOR DRAWING OF PROPOSED DEVELOPMENT:
(To befilled in by individual proposing development)
S�
2/ Z/
p 0
(Information for Property Owner Applying
for Permit)
'? O '-�> d Y a So
Mailing Address
(Riparian Property Owner Information)
Signature
AAfm,jic, bet -Lk
City/State/Zip Print or Type Name
W 6 - 28% S Z-s 2227 ZI )((
Telephone Number Telephone Number
Signature
Date
Date

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERIMOORING PILINGS ]B(OATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to f 'F 'f is
(Name of Property Owner)
property located at / !
(Lot, Block, Road, etc.)
on C-.4i,-=Q4-, ,in
(Waterbody)
Applicant's. ph —7 Z6 7-96 S
A4(-,9n i< , N.C.
(Town and/or County)
M'aiTi ng Address: 7p, O
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 / boadift / boathouse
must be set back a winirnum distance of fifteen feet (15") from my area of riparian access tmless
wanted by me. (If you wish to waive the setback, you must initial the appropriate blank
bow.)
I do not Irish to ware
I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOP NT:
(Top be filled is by individual proposing derelopnwa)
C" S
Zt 2/
a
� � � �► -S
(Information for Property Owner Applying
for Permit)
-P (i Rox a
Mailing Address
bInAL,
city lstatemp
Telephone Number
(Riparian Property Owner Information)
a�� Signature
xrt or Type Marne
Telephone Number
Signature Date Date

NCDENR
;•ji;;i r: ,.JliCj['7j-r P�'-II rnvirCnmerii" a!-!� 111. it -�i j.Jl
3everi/ caves '?erdue, governor G regson, 172*tii f Gee ; reem. an,
Date 2, 2i1 - [
applicant N,.,
Mailinb Address - O 2So 44L,4-r� ► c ' -,c4 c�h N • C , 2�SI Z
I certify that I have authorized (agent) (Yl �� `��- �k� 1— to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity)
at (location) -O-K- 114
This certification is valid thru (date)
Signature
400 Commerce Avenue, Morehead City, North Carolina 28557
Phone: [phone] \ FAX: [phone] \ Internet: www.nccoastalmanagement•net
An Equal Opportunity \ Affirmative Action Employer — 50% Recycled \ 10% Post Consumer Paper

ALFRED B COOPER JR
PO BOX 250
ATLANTIC BEACH, NC 28512
PAY TO THE
ORDER OF-
FIRST CITIZENS SANK
firstckizens.com
1502
66-30/531
133
2/25/2011
A
m
0
**600.00
0
************ DOLLARS
NCDENR 011d1617 Mail Service Center
Raleigh, NC 27699-1617
MEMO e^ I. , 9 i l Co12 �.,
North Shore dredging AUTHORIZED SIGNATURE
1100OL50211' j:053L00300i:001,317523699jj'