51829_COONEY, MICHAEL_20090508

❑CAMA / ❑ DREDGE & FILL
GENERAL PERMIT
Ll New ❑ M(Odificjition [-]Complete Reissue ElPartial Reissue
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
Applicant Name
Address
City State •i '� zip
Phone # (:) `_�.� (O'�tj Fax # ( )
Authorized Agents ric lit
Affected ❑ CW ❑ EW LJ PTA ❑ ES ❑ PTS
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS: ❑FC:
ORW: yes / no PNA yes / no Crit.Hab. yes / no
Previous permit #
Date previous permit issued
Project Location: County
J] Rules attached.
Street Address/ State Road/ Lot #(s)
Subdivision
City Jr:Y ZIP
Phone # (25 ) 7 — 7171; River Basin
Adj. Wtr. Body �,� a' \ i� C dNA14- fnat /man /unkn)
Closest Maj. Wtr. Body
Type of Project/ Activity
• .. ..i
" ■■■■■®■■■■■■■■■■■■■■■■■■■■�■a�+■,mow■■�■
■■■■.
■■■
■■■■■■■■■■■■■■■®i■■I■■■■■■�,�■��■■■■■■
- -■■■■■■■■■■■■■■■■®wi■■i■■■■■■■■■■■■ice■■■■■
No
i
Agent or Applicant Printed Name
Signature Please read compliance statement on back of permit
Application Fee(s) Check #
Permit Officerr�$ignatu re
)oc; d9do
Issuing Date Exp rati n Date
71. ()r0-7oc�
Local Planning Jurisdiction Rover File Name

o 0
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, certifythat 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
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

"ADJACENT RIPARIAN PROPERTY OWNER STATENSENT .
(FOR A PIER/MOORI_NG PILINGSIBOATLIFT/BOATHOUSE)
� V is
I hereby certify that I own property adjacent to ee eoo,v e
(Name of Property caner)
property located at /.2 7 qp Ac6 '
(Lot, Block, Road, etc.) on /2 i ®Af1 /f� in C���gal&t , N.C.
(Waterbody) (Town and/or County)
Applicant's phone #: 910--1-91- " Mailing Address:d�L
He 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 / boatlift / boathouse
must be set back a minimum distance of fifteen feet (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 not wish to waive
I do wish to waive that setback requirement.
-----------------------------------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
'L (To be filled in by individual proposing development)
1
------------------------------------
Coy J ----------------------------------------
-------------
(Information for Property Owner App Vying (Riparian Property Owner Information)
for Permit)
Mailing Address
AAM
City/State/Zip
Signature
Print or Type Name
Telephone Number
a0 -99
Date

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
MichaelF. Easley, Govemor James H. Gregson, Director William G. Ross Jr., Secretary
Date
Name of Property Owner Applying
for Permit:
Mailing Address:
/ Z z4416
.CJL� Aj—A4 /r, L�' 2- A�
I certify that I have authorized (agent) ! 1 801�F14M 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)
a 7
r �u
ty Owner Signature Date
400 Commerce Avenue, Morehead City, North Carolina 28557
Phone: [phone] FAX: [phone] Internet: www.nccoastalmanagement.net
An Equal Opportunity 1 Affirmative Action Employer — 50% Recycled 110% Post Consumer Paper

.Z ,� � ;�' - 1 113. i9 ZJ v � :i r� -NE a S rd- i r is i
'. 9A-' ���� chi S#+s1aT�LivY/� �.9�A I1�'11a1
(FORA PIER!WOORIIVG P'I.L1iNv.SIIBOAT LI F'TIBOAT�UO USE)
I hereby certify that I own property adjacent tof1� ��p s `
(Name of Property wner)
property located at IZ 7 s Ao�� d...if/l
(Lot, Block, Road, etc.) ��
on �2 %� C , l l , in � .�'e� fi, fh , N.C.
(Waterbody) (Town and/or County)
Applicant's phone #: 7/Ci' � �� Mailing Address: �� 1l
i� 24�! 2 —k
He 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 / boatlift / boathouse
must be set back a minimum distance of fifteen feet (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 not wish to waive��
I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
_ --
--------------------------------------- � - ity -------------------------------------------
(Information for Property Owner App ying (Riparian Property Owner Information)
for Permit)
Mailing Address
City/State/Zip
Signature
Yi
Print or Tyf e Name
G q")- 7
Telephone Number
171 e
Date

�.. ,i„
.. -. -._.. - .. ..-S�'.