57124_COOPER, A B_20110224

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❑ CAMA / ❑ DREDGE & FILL ''
GENERAL PERMIT Previous permit #
❑New ❑Modification ❑Complete Reissue El Partial Reissue Date previous permit issued 7
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 I SA NCAC
❑ 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 ❑ PTS
❑ UBA ❑ N/A
Crit.Hab. yes / no
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
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Agent or Applicant Printed Name
Signature ** Please read compliance statement on back of permit"
Application Fee(s) Check #
Permit Officer's Signature 1
Issuing Date Expiration Date
Local Planningjurisdiction 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 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.
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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No licant:
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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
ternimpacts)
FINAL Sq. Ft.
(Anticipated final
disturbance.
Excludes any
restoration
and/or temp
impact amoun
TOTAL Feet
(Applied for.
Disturbance
total includes
any anticipated
restoration or
ternim acts
FINAL Feet
(Anticipated final
disturbance.
Excludes any
restoration and/or
temp impact
amount
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f dge FiII ❑ 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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Bever!y Eaves Rerc'ua, �Ovenncr J�j-nes r�j, Gregson, DiractOr Dee 1--(eemor,
Date -Z- Z I -
Applicant Name 00 per
Mailing Address 6)( SC7 et c,
C. , )-� SIz
I certify that I have authorized (agent) MU —ID y C- f�'e � to act on my
behalf, for the purpose of applyinc, for and obtaining all LAMA Permits necessary to
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install or construct (activity) 'Of , dq< � a c, 4 5 1 �
at (location) 0, IV � / II '5l 0'4t N H P
This certification is valid thru (date)
Signature
400 Commerce Avenue, Morehead City, North Carolina 28557
Phone: [phone] \ FAX: [phone] \ Internet: www. nccoastaimanagement. not
An Equal Opportunity \ Affirmative Action Employer — 50% Recycled \ 10% Post Consumer Paper

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERIMOORING PILINGSBOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to 14 �3 c e2� s—; r{ ` 'S
(Name of Property Owner)
property located at (4 ti's � og ) ,
(Lot, Block, Road, etc.)
on W , in r47 N.C.
(Waterbody) (Town and/or County)
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Applicant's, Irltcrne #s 'Z C NlarTinrg Addre$a: r- `�' ao 2 S o
����-lti l��-�c�. 1.�•c.2�a'S�2
He has described to rare, as shy 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 minimum distance of fifteen feet (1.5) from my area of riparian access unless
waived by m, e. (If you wish to wive the setback, you must initial the appropriate blank
below.)
I do not wish to waive
I do wish to waive that sefck requirement.
DESCRIMON ANDIOR DRAWING OF PROPOSED DEVELOPMENT:
3 j 4 (Ta Ire filled in by irr&s ideal prerposing devela parent)
3�
4-
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izy (a,l q
2to��yAS
( 1aformation foc Property Owner Applying
for Permit)
P.'D- lox 250
Mailing Address
N.C. 28S )2
City/State0p
Telephone Number
(Riparian Property Owner Information)
Signature
ls"y 41 Vol"
Print or Type Name
2 C 1--- -7 L � I -� -) �
Telephone Number
•Z_Zo -it
Signature
Date
Date

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILI7VGSBOATLIFT/BOATHOUSE)
I hereby certify that I own property adjacent to 's
(Name of Property Owner)
property located at I"Z-z 1
(Lot, Block, Road, etc.)
on 9 w j3 , in r-rT L:1 r.., 1 L .sc h , N.C.
(Waterbody) (Town and/or County)
Applicant's phone #: 2 (� Z'81—'5 Mailing Address:
?,Dz q3 0-�, 25 O
A S �J . 2e?5 / Z
I Ie 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 minimum, distance of fifteen feet (I 5) 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
I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT.
3 j 4 (To, be filled to by individual pr�rpostng development) f (�
3�
40 L���
Z, I z
�o�A 3Zc�-Yo5 S DC
(Information for Property Owner Applying
for Permit)
Yo 1 o-� 25 0
Mailing Address
(Riparian Property Owner Information)
9
I'J�L.�4J-i-yt. ���G�� N.C•2�/Z ���/✓/l�.S/fil/riy%�%i;
City/State/Zip Print or Type Name
`7Z6 2T6S'
Telephone Number
Telephone Number
Signature Date Date

1502
ALFRED B COOPER JR FIRST CITUENHBANK 66-36/531
PO BOX 250 firstcitizens.com 133
ATLANTIC BEACH, NC 28512 2/25/2011
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PAY TO THE 1 ""600.00 0
ORDER OF NCDENR
DOLLARS
Six Hundred and 00/100*'`
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NCDENR
1617 Mail Service Center
Raleigh, NCC27699-1617 ✓j ? LL
MEMO ��� I r� I, J ( 1 `' �
North Shore dredging AUTHORIZED SIGNATURE
11.001SO211' 1:0S3L00300400L31?S2369911'