Willis, Cooper 79653C

ENERAL PERMIT Previous permit # J
New 11Modification ElCol5plete Reissue ❑Partial Reissue Date priavious permit issued
As authorized by the State of North Carolina, Department of Environmental Quality
and the Coastal gesouM Commission In an rBa of env' onmental concern pursuant to 15A NCAC
', [as attached.
Applicant Name _ Project Location: County_
/ 17 C641
Address_ Street Address/ State Road/ Lot,4(s)
'City 41 U,.K State-LVL ZIP 6
Phone #
Authorized Agent
—\tom - ---
Affected ❑ Cw I�EW L�yP tBA
❑ PTS
AEC(s): ❑ OEA O HHF ❑ IH ❑ N/A
n Pw
ORW: yes / es / n
Type of Project/ Activity
Pier(dock)length
Fixed Platform(s)
Floating Platform(s)
Finger piers)
Groin length?
=*_rBulprep length
avg distance offsho a _�
max distance offshore s
Basin, channel
cubic yards
Boat rampr ----^
ice'
Subdivis' n
City too
Phone # ._
Adj. Wtr. Body
Closest Maj. Wtr. Body
D41
i
Boathouse/ Boatlih� I
i
Beach Bulldozing—_-_— I _ �
Other 1 1�. i_
i
Shoreline Length l!-
SAV: not sure yes no (� +-
�/ Moratorium: n/a yes no
Photos:
Waiver Attached: I- . _.
A buiidin permit i e req ' y: [� See tote on back regarding River Basin rules.
( Note Local Planni jurisdictio )
Notes/ SF cial Conditions3_
r l , i m f n A. r. _. t
— --li -- ----- - - - -
cant Pr c ame Permit Ificer's Prin
�j�e e t ad compliance statement on bac f�Qern Sig ature
Fees Check Iss mate xpiration Date

CAMA / ❑ DREDGE & FILL*,
--.
? 7=,';
; - t. s:j A
B C D
ENERAL PERMIT
Previous permit#
New ❑Modification ❑Complete Reissue ❑Partial Reissue
Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality
and the Coastal Resour Commission in an
rea of env ronmental concern pursuant
to I SA NCAC
Wiles attached.
Applicant Name
Al.
Project Location: County_
Address
Street Address/ State Road/ Lot s)
City
State ZIP_
Phone #�W _ r---
Subdivis' n
Authorized Agent
City ZIP
[IPTS
El cwwtBA
Phone # ) ver Bas•
(96
Affected
AEC(s): EloeA [IHHF ❑ IH El N/A
Adj. Wtr. Body__
at / n /unkn)
❑ PW
ORW: yes / PNA yes / n('0 1
Closest Maj. Wtr. Body
— 1 4
Type of Project/ Activity
t
Pier (dock) length
Fixed Platform(s)
Floating Platform(s)
Finger pier(s)
Groin length
er
Bul a iprap length
avg distance offshoMell
max distance offshore �\
Basin, channel V
cubic yards —
Boat ramp ----
Boathouse/ Boatlifr------
Beach Bulldozing
Other
i
Shoreline Length
SAV: not sure yes
........ .....
Moratorium: n/a yes no
Photos: es
c
Waiver Attached: e o
A build inppermit e re q � y: 7
( Note Local Plan nirV Jurisdictio )
Notes/ S cial Conditions
1) �. . _ AA II '
plicant Printed Name
4NiIV Ir4
m
(Scal1e• )
inl
0
I
4 ❑ See note on back regarding
Permit Officer's
Basin rules.
read compliance statement on
re
Application Fee(s) Check #r Issuing Date ( 'Expiratio6 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, 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 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/ I-888-4RCOAST 252-946-6481
Fax: [phone] Fax: [phone]
(Serves: Carteret, Craven, Onslow -
North of New River Inlet- and Pamlico
Counties)
Elizabeth Cif 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)
(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 - South of New River Inlet -
and Pender Counties)
http://portal.ncdenr.org/web/cm/dcm-home
Revised 7/06/ 17

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to Coop-ey- Io l l r5 's
(Name of Property Owner)
property located at I �_� s� si:�o
onuti� (Address, Lot, Block, Road, etc.)
in DItNG42\ 'b� _ N.C.
(Waterbody) (CityfTown and/or C unty)
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 fill In description below or attach a site drawing)
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, 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.
'`4w �1y I do not wish to waive the 15' setback requirement.
on)
Sig crlc�}•e /l � �J,�l/S. (mil><] /'J--t.✓
Print
N
vny'. t04VrL.1'V
Telephone Number / email address
Date
(Adjacent Property Owner Information)
ailing 0 Ci Oya-VC%
� �� y�te/Zip9/3 1115��-33�
Telephone Number/email address
Da(e'
(Revised Aug. 2014)
`Valid for one calendar year after signature"

ADJACENT RIPARIAN PROPERTY OWNER §TATEMENT
I hereby certify that I own property adjacent to c.' ].PTV- Lzd ` r�> 's
(Name of Property Owner)
property located at��>
(Address, Lot, Block, Road, etc,)
ontJ1� , in � _ N.C.
(Waterbody) (CitylTown and/or
Cdunty}J
The applicant has described to me, as shown below, the development proposed at the above
loc ion.
_ I have no objection to this proposal.
�J
G __,���. !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
I understand that a pier, dock, mooring pilings, boat ramp, 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.)
do wish to waive the 15' setback requirement.
_ m _ I do not wish to waive the 15' setback requirement.
(Pr9EfertyPW#r Information) (Adjace/ht Pf peyt-One�lnformation)
Malin Ad Maiti1i Abdre f
Ci / at t
Teteph ne Number /email addre ss� del p o e Nu Aber /email
Date Date•
(Revised Aug. 2014)
"Vaud for one calendar year after signature'

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