Cooper, AB

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❑CAMA / ❑ DREDGE & FILL N2 70445 A B C D
GENERAL PERMIT Previous permit #
[]New ❑Modification ❑Complete Reissue t ''Partial,Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
❑ Rules attached.
Applicant Name rrolect Location: t,ounty
Address Street Address/ State Road/ Lot #(s) _
City State ZIP
Phone # ( ) E-Mail Subdivision
Authorized Agent t / t (( ;!-t City ZIP
ElCW ❑ EW ❑ PTA ❑ ES ❑ PTS Phone # (./=1ktver Basin
Affected ElOEA ❑ HHF ElIH ❑ UBA El N/A AEC(s): Adj. Wtr. Body (nat" /man unkn)
❑ PWS:
ORW: yes / no PNA yes / no Closest Maj. Wtr. Body
Agent or Applicant Printed Name Permit Officer's Printed;Name f
t S /
Signature ** Please read compliance statement on back of permit Signature
Application Fee(s)
Check #
Issuing Date Expiration Date

ik-
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 rOther:
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 (252-946-648I) or the
Wilmington Regional Office (910-796-7215) for more information on how to comply with 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/ I-888-4RCOAST 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
401 S. Griffin St.
Ste. 300
Elizabeth City, NC 27909
252-264-3901
Fax: [phone]
(Serves: Camden, Chowan, Currituck,
Dare, Gates, Pasquotank and Perquimans
Counties)
http://portal.ncdenr.org/web/cm/dcm-home
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)
Revised 7/06/ 17

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CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner:
Address of Property:
Agent's Name #:
Agent's phone #:
(Lot or Street #, Street or Road, City & County)
Mailing Address:
I hereby certify that I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing the development
they are proposing. Mtisions rnust.be pravrtled.with )hisl°efter.
I have no objections to this proposal. I have objections to this proposal.
If you have objections to what is being proposed, you must notify the Division of Coastal Management
(DCM) in writing within 10 days of receipt of this notice. Correspondence should be mailed to 400
Commerce Ave., Morehead City, NC, 28557. DCM representatives can also be contacted at (252) 808-
2808. No response is considered the same as no objection if you have been notified by Certified Mail.
WAIVER SECTION
I understand that a Mier, 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 t waive the setback, you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
to waive the 15' setback requirement.
(Property Owner Information)
no1,
/ Signature
f
' S� r �2 .
Print or Type Name
( Ss Gucec ltlto�i
Mailing Address
City/State2ip '
9[9 —/, s� --7— 33fi
Telephone Number
(Adjac nt rope y Owner Information)
Signature
CJ k L
Print or ype lame 20Z D6VC,
51�1
Mailing Addre �—'
�Acwk L " PC 2,�StL
City/State2ip
2.-71. 50c1[,nrQ ;1VE
Telephone Number
MAR 2 2 2018
Date -`, _ f Date SQM D CITY

i ,�
CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner:
Address of Property: A[" v c , , ur oV J r .� ,��
(Lot or Street #, Street or Road, City & County) Cy.✓�c� �� Cv�.�}y
Agent's Name #: _J1L�-�� I Mailing Address:
Agent's phone #: T fU ,
I hereby certify that I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing the development
they are proposing. A desc�rpt�on or drawrngfi5withtd'imen"s a;o -, ust be pt ide�f�iuH h I�rsefter.
/ ( I have no objections to this proposal. I have objections to this proposal.
If you have objections to what is being proposed, you must notify the Division of Coastal Management
(DCM) in writing within 10 days of receipt of this notice. Correspondence should be mailed to 400
Commerce Ave., Morehead City, NC, 28557. DCM representatives can also be contacted at (252) 808-
2808 No response is considered the same as no objection if you have been notified by Certified Mail.
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.
(Property Owner Information)
Signature
e- 5 12, %t% r C vS
Print or Type Name
Mailing Address
Aar m W, -2-7>0�
City/State2ip
1?[ i�g _ 2 334:1_
Telephone Number
Date
(Adjacent Propertypwner Information)
Signgtple
Print or Type Name
Mailing Address
)AA 11 ►� �1.A D �� ti r, 1 �i ( 7
City/Statelzip
J1q Lfgr 1RECEIVED
Telephone Number
MAR 212018
111/�01 6-
DaW LDCM- MMHD CITY
Revised 6/18/2012

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
' I hereby certify that I own property adjacent to J G! �Lc 'J is
�. r c vS
ame of Property Owner)
property located at _ 7 r9 lyr'10-4 51 ,0,t-6 /(
(Address, Lot, Block, Road, etc.)
on 40,1 u d in i 1 'h'c gc 11C , N.C.
( aterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
4_ 1 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)
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
wishto waive the setback, you must initial the appropriate blank below.)
/
+i' / �* I do wish to waive the 15' setback requirement.
i� I do not wish to waive the 15' setback requirement.
(Property Owner Information)
S' nature
J r" C S /Z .
Print or Type Name
Cyr woce1c"tc q ,
(Adjacent Protln
Owner Information)
c�
Sigrt1ature
m Asti(.,
PrIPPri or T e Name
'�- wq�l
Ma(7in Address
Cityl a IZ
Telep�e,N � 7r
Date
(Revised 611812012)