61094_COOPER, A B_20121017

❑C.AMA / ! DREDGE & FILL
y
NO. 61094
GENERAL PERMIT
Previous permit#
LlNew ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
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
Rules attached.
Applicant Name i
Project Location: County
Address
Street Address/ State Road/ Lot #(s)
City State ZIP:
-
Phone # () ;— Fax # () _
Subdivision
Authorized Agent _ _ _
City ZIP
_ _
Affected -J CW ❑ EW J PTA J ES h PTS
Phone # ( _) — River Basin
AEC(s): J OEA HHF C IH UBA i= N/A
Adj. Wtr. Body (nnt /man /unkn)
❑ PWS: I
ORW: yes / no PNA yes / no Crit.Hab. yes / no
Closest Maj. Wtr. Body
Type of Project/ Activity
Pier (dock) length_
Platform(s)
Finger piers)
Groin length - -I--i
number
Bulkhead/ Riprap length
avg distance offshore
max distance offshore
Basin, channel
cubic yards __
Boat ramp —
Boathouse/ Boatlift
Beach Bulldozing -
Other_
e,.
Shoreline Length
SAV: not sure yes no
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
•; I 1 'IJ
Agent or Applicant Printed Name
Signature Please read compliance statement on back of permit
Application Fee(s) Check #
-
�- 1
i
i
See note on back regarding River Basin rules.
Permit Officer's Signature
Issuing Date Expiration Date
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
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)

MUD BUCKET DREDGING INC
507 HEDRICK BLVD
MOREHEAD CITY, NC 28557-3045
Date 10. f—I ) Z-
6012
66-112/531
s
O
Pay to the c- �j 12
Ag! order of
Doffars
BRANCH BANKING AND TRUST COMPANY
1 -800-BANK BST B8T.c0m
FOR ------Iu
-
11,000OP30 1 211n 1:0 5 3 10 11 2 0:000 S 2 9 3 2 L 13 3 1. L
L

�14
N.C. DIVISION OF COASTAL MANAGEMEN T
AGENT AUTHORIZATION FORM
Date lo-lo-i
Name of Property Owner Applying for Permit:
<f P e-
Mailing Address:
-C-)
,,,4� -, C.
I certify that I have authorized (agent) j� �� ��T 1�r��ri r� 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)
Property Owner Signature Date

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
X
I hereby certify that I own property adjacent to �8, r' 's
arne of Property Owner)
property located at zU (� ? 2�h done- L
(Address, Lot, Block, Road, etc,)
on q L in h , N.C.
(Waterbody) (City/Town andlor County)
The applicant has described to me, as shown below, the development proposed at the above
location.
5- p I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
A n�6,o
J-T J7r - NT
13C. ) 3 ) 0, � LAo
WAIVER SECTION
understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set
back a minimum distance of 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 wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Prop))ity O,#ner Informati%�-.-1 (Adjacent Property Owner Information)
IS'_-us.pe- r
P iT
�nt or y e Name
' J t3�,;T S v
ailing Addre,�
oz_" 2545)2
City/State/Zip
26 Zs6S
Telephone Number
1©"t©,i2
Date
Sign ure
C2
Print or Type Name
Mailing Address
City/StatelZip
25-z 7--23 -7 -7 -7`6
TelephonelNurber iZ
Date
(Revised 611812012)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
i hereby certify that I own property adjacent tc h��_ s
�{�larr�e of Property Owner)
located at _ �0Co 1.So2-�h � h�?�"�y'
C (Address,, L t, Block, Road, etc.) -
on -- g
"'—�- --- in Lrr
��-t,c lkoN.C.
(Waterbody) (City/Town andjor County)
The applicant has described to me, as shown below, the development proposed at the above
location.
GS I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
Pr0r;-4-9
� Lc i,A aAS a
4
1
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Y 13' )(D "
O C 1 17 2012
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set
back a minimum distance of 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 wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Proggrty 0,Wner I
A, 4v Z) A&
Print orlype Name
0 bo v ZSJ
Maili g Address
- L 0, �a- N � ZgSt Z
City/State/Zip
I Z(0 'z�VS
Telephone Number
Date
(Adjacent Property Owner Information)
Signature
G L C ,+/Ar .Sj,9U�6-T-r-S
Print or Type Name
Ft)- Rix 7A7
Mailing Address
adA� gc nc-4 C4- .� C
City/State/Zip
1 z,1,5�2 -,2 y/- 3 d?G
Te ephone Number
Date
W ink
(Revised 611812012)

Describe balcw the HABITAT disturbances ter the application. All values should match the name, and units of measurement
found in your Habitat code sheet.
Habitat Plante
DISTURB TYPE
Choose One
TOTAL Sq. Ft.
(Applied for.
Disturbance total
includes anv
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 final
disturbance.
Excludes any
restoration and/or
temp impact
amount
LLIXDredge
❑ Fill ❑ Both ❑ Other
IVX12
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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 ❑