Cooper, Bob

ECAMA';q & FILL
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,DRFEDGE
A B D
GENERAL PERMIT
Previous permit #
!]New ElModification OComplete Reissue
ElPartial 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 ISA NCAC
EIRules attached.
Applicant Name
Project Location: County
Address
Street Address/ State Road/ Lot #(s)
CityState 1,,' ZIP
—1
Phone # E-Mail
Subdivision
Authorized Agent
City- ZIP
PTA ❑ ES 0 PTS
El CW bEW I
Phone # River Basin
_LJ
Affected
D OEA El HHF El lH 0 UIBA 0 N/A
AEC(s):
:_-,0 � i I I(", '__�man
Adj. Wtr. Body (Ln at /un!Ln)
0 PWS:
`�O�
Closest Maj. Wtr. Body'
PNA no-"
ORW: yes I yes
�e of Project/ Activity
Pier (dock) length
Fixed Platform(s)
Floating Platform(s)
Finger pier(s)
Groin length
number
Bulkhead/'R'Iprap length
avg distance offshore —
max distance offshore --rc-Tt
Basin, channel
cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
Shoreline Length
SAV. not sure
yes no
Moratorium: n/a
yes no
Photos:
yes no
Waiver Attached:
s no
(Scale:
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IMEME,
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No
MOM
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A building permit may be required by: El See note on back regarding River Basin rules.
Note Local Planning jurisdiction) r- f, r
1 V f-4
Notes/ Special Conditions e� VC
Agent or Applicapt Printed Name Permit Officer's Printed Name
5 cl 7
4
""Please read compliance statement —on' bidkof permit`'Signature
Sipature/
Application Fee(s) , -----.—Check# Issuing Date Expiration Date

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, certifythatthis project is consistentwith the North CarolinaCoastal 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 Resources. Contact the Division of Water Resources at the Washington Regional Office (252-946-6481) or the
Wilmington Regional Office (910-796-7215) for more information on how to complywith these buffer rules.
Division of Coastal Management Offices
Morehead City Headquarters
Washington District
400 Commerce Ave
943 Washington Square Mall
Morehead City, NC 28557
Washington, NC 27889
252-808-2808/ 1-888-411COAST
252-946-6481
Fax: [phone]
Fax: [phone]
(Serves: Carteret, Craven, Onslow -
(Serves: Beaufort, Bertie, Hertford, Hyde,
North of New River Inlet- and Pamlico
Tyrrell and Washington Counties)
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)
Wilmington District
127 Cardinal Drive Ext.
Wilmington, NC 28405-3845
910-796-7215
Fax: [phone]
(Serves: Brunswick, New Hanover,
Onslow - South of New River Inlet -
and Pender Counties)
http://www.ncco=almanagement.nett
Revised 08/27/14

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to 3 CM 15
h (Name of party Owner)
/-y property located at ��`b �Gr �L� oa r 1 `0 \ h�
ep,.�, �� (Address, Lot, Block Road, etc.)
on x%rc� `� , in � �_'_ ? . N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
locatfo .
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 orattach a site drawing)
! n, o
i✓ ECEIVED
DEC 29 2015
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, DOW M H D CITY
must be set back a minimum distance of IV from my area of riparian access unless waived by
me. (if you wish to waive the setback, you must Initial the appropriate blank below.)
l� I do wish to waive the 15' setback requirement.
I do not wish to waive the I & setback requirement.
(Prope Owner n ormation)
SignaqTe
lr U
Print or Type Name
1MailingAdd�resN `7
City/stataop
T f phoy�tllumema�7 address
d / /15—
Date
"Valid for one calendar year after signature*
(Adjacent Property Owner Info ation)
afore*
� v1% V1C , 1) _
PnntorTlpeName
Malling Address
City/State2'
2SZ"1:3a 65I �Cw� 1):�nt �r� c?�nb
.raj a.;� �Gts►�
Tetephone Number/email address
(2.-S-1Y"'
Date*-
(Revised Aug. 2014)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to
"
property located at(`lam Property Owner)
cp,�Ly (Address, Lot, Block Road, etc.)
on _ ,t� . in `T�! V= St N.C.
(Waterbody) (CityiTown and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must flil In description below orattach a site drawing)
wllkm- as
cd '
RECEIVED
WAIVER SECTION 2 9 2015
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or g
must be set• back a minimum distance of 15' from my area of riparian access unless waived by
Lo me. (if you wish to waive the setback, you must Initial the appropriate blank below.) DC M_ M H D CITY
I do wish to waive the 15' setback requirement.
do not wish to waive the 16 setback requirement.
U '
Pro a Ow Information)
( p, o ation) JAace,"nt Prope Owner information)
Signature S lure
-- A IAA V 12 C 2
Irl-10
Print or Type Name P ' 7yName
-37 0
Ma17.! t / r=
Date
`Valid for one calendar year after signature"
Date'
ALlq -05a 3
Numberl email addre:
(Revised Aug. 2014)

Permit No.:'.
Applicant's
Project Address: I
Please retain rebeipt.for records as proof of payment for permit issued.
Jiranf• n nJ. 1

Dec 21 15 09:46a Cary License Agency
[phone] p.1
3330
N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
� J
Date
Name of Property Owner Applying for Permit:
000/-;70
Mailing Address:
5o v�ArIZ=Iq104 J�
I certifythat I have authorized (agent) 11 m 69 11-n e S
(g ) to act on my
behalf, for the purpose of applying for and obtaining all CANU Permits necessary to
install or construct (activity) 5 c A W A !.
at (my property located at) / % Dy 1q /(1 L' � � (A3 Ado ✓e
This certification is valid thru (date) 4 /C. / . aO16.
Property Owner Signature Date
WjwEN ED
DEC 2 9 2015

• 1 G-16-'15 10:10 FROM- T-475 P003/005 F-138
Pnn
The following notice applies t0 consumer customers onfir
- SUBSTITUTE CHECKS AND. YOUR nlaHTS page 3 of 4
What Is a Substitute check?
To make ohock processing taster, federal 10W permits banks to replace original checks with "substitute ohecks ° These checks are simlfor in size to original
checks Willi a sllghliy reduced Itnage of the front and book of the original check The front of a subafilute check stater. "lints is a legal copy of your ctneck. You
can use N the same way you would use the Original check" You may use a subab7uts check of proof olpoymaW iut like the o4gtnol check
some or OR of fhe ohecks fhat you rccelve bock from us may be suhs6htte checks, Tivs malice descnr es nghta you have when you reeeAre subsUfute checks
from Us The fights In this nofice do not apply to original checks or to electronic debits to,your ocoounk However, you hope nghta under other With respect
to those hvnsactfotns
Wryat are my rights; regarding substitute checks?
In certain cases, tederal,taw provides a speclal procedure that allows you to request a refund for losses you Sutter N a substitute check is posted 10 your
account ((or example, if you lNnk that we wllhdfew the wrong amount trom your aocount or that we withdrew money from your account more man once tar the
sarpe check). fie losses you may attempt to recover under this procedure may Include the amount that was withdrawn from your a000uht and fees tho► were
clanged as a result of the wrf ckvoi (for example, bounced ohsck fees).
The amount of Your refund under flits procedure is lhdled Io Nt amount of your Joss or Me- amount vt the subsMule check, whichever is fam You also . are
entitled to interest on the amount of your refund t your account is an 7nferest•ba wng account 8 your bss exceeds the amount of the SUbsiRuf a check you
may be able to recover addUlonat arnounfs under other low.
1012015 Ln NV
OQOUO2LD0148887 ......: .................� .«. :: .... r.,,.:.....�..�.:x.,�, �r~W.,
Thle is a LEGAL, COPY of your r- i aaralw,+s.y,r 6299
waychey You would
use h the same r u C 011031 RANKS MARINE CONSTAWTION, INC rWdnt
► he yvtr would use the vt�iginal r� E3 e tsai FIAST AVE
oheC CON MOREHEAO MY, NC 29997 irnut:w�
r u • (:5212404W
RETURN REASONr-A a�
NOT a ��j�'1�17J�.L.T.EN 1 . Q PAYTOTI"! it
FUIYiIS .11 ` OROEROF
POl1Ag6 8
E3 ra
©N fkOQ29], Q MEMO, a GPS )f c .•• 67683r,- yc6.
pitsu M
• u`d06244u■ f;053�f,�p300t:Gf�l,3i�; 2187u+
114006 29904 '41:0 5 3100 3001:0013 12113 2 1 2 7u'
GL B.alo.ncing IfeM for Re -Deposit
ranch:.
086
Secquence Number. "
2600148887
Account Charged:
1033086000
ttetum Amount.
$800.00
Casts Notice Date:
12-10.2015
For check reference only;
Account Number Depositing:.
0865001213
0,00000a0000.Ir
RECEIVED
DEC 2 9 2015
®CM_ MHp CITY

NC Division of Coastal Management
Cashier's Official Receipt 1273 ABC D
Date: 20 /9)
Received Fi
Permit No.:
Applicant's
Project Add
n [�
Please retain
Signature of Agent or Applicant:
Signature of Field Representativ .
for y records as proof of payment for permit issued.
Date:
Date:
�ECE1V ED
DEC 2 9 2015
pCM- MHO CITY

Prownlow, Ro
From- Sebastian, Meliss6
Sent: Monday, December 21 2015 1:33 PM
To: Brownlow, Roy
Subject: Tim Grimes
Wow after writing down what, 1, have4hln&Aren't sure black and white -hopefully you will have the other pieces and it
will be.
12-7 received $800 check (6299) for GP 67083 (Steven Silver) and new PKS gp for Bob Cooper (permit 664593). -
Deposited check on 12-8. Received N$K notice from!;Ralelghon 12-16.
12-9 receive permit not issued at time if payment but according to receipt it was for 407 AB
Causeway.
He came in on 12-18 w, money order for $800 picked up permit 66462 Crows Nes 0
*e&6a Sd66aw, �e 0 11��
i 'Money order f,
------- P5-
ge t
Man;
Accounts Pa 'r X/ yable Mgr.
NC Division of Coastal Manage. t tal ualit
NC Dept of Environmental Quali
7j/
252 808 2808, ext 229
252 247 3330 Fax
[e-mail]
400 Commerce Ave. 7
Morehead City,.Nc 28557 IPA,
ti
�Nothing comipares,-i-,,
RECEIVED
Email correspondence to and from this address is subject to the
North Carolina Public Records Law and may be disclosed to third parties.
DEC 2-9 2015
90c
Zia
DCM- MHD CITY