54349_COOPER, AB_20090803

❑CAMA / ❑ DREDGE & FILL R,1 `;0
GENTERAL PERMIT Previous permit #
❑New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environment and Natural Resources
4
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
❑ Rules attached. i
Applicant Name _ Project Location: County
Address
City
t
State ZIP `.
Phone # ( )
Fax # ( )
Authorized Agent
❑ CW
❑ EW ❑iPTA ❑ ES ❑ PTS
Affected
AEC(s): ElOEA
ElHHF ElIH ❑ UBA ElN/A
❑ PWS:
❑ FC:
ORW: yes / no
PNA yes / no Crit.Hab. yes / no
Street Address/ State Road/ Lot #(s)
Subdivision
City
ZIP_
Phone # ( ) River Basin l �_
I
Adj. Wtr. Body (nat /man /unkn-
Closest Maj. Wtr. Body
Type of Project/ Activity
-
Pier (dock) length
(Scale:
Platform(s)--
I
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length
i
r
`
avg distance offshore
max distance offshore
Basin, channel
cubic yards_----,r�.
t
Boat ramp
—
---
,
Boathouse/ Boatlift
Beach Bulldozing
\
Other
1
Shoreline Length I
SAV: not sure yes no
Sandbags: not sure yes no
Moratorium: n/a yes no
Photos: yes no _
�
1 The time period requirement for this
_
Authorized i.evelopment is suspended
untlf December 31 2010 pursuant to
I
the "Permit Extension Act of 2009.
Waiver Attached: yes no
A building permit may be required by:
C See note on back regarding River Basin rules.
Notes/ Special Conditions
Agent or Applicant Printed Name
Signature ** Please read compliance statement on back of permit
Application Fee(s) Check #
PermitOffecer's Signature
Issuing Date Expiration Qate
Local Planning Jurisdiction Rover File Name

IV
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/ 1-888-4RCOAST
Location: Fax: [phone]
2728 Capital Blvd.
Raleigh, NC 27604
919-733-2293
Fax:[phone]
(Serves: Carteret, Craven, Onslow -above
New River Inlet- and Pamlico 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)
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

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Michael F. Easley, Govemor James H. Gregson, Director William G. Ross Jr., secretary
Date � - /Z U%
Name of Property Owner Applying for Permit:
Mailing Address:
I certify that I have authorized (agent) to act on my
behalf, for the purpose of applying for and obtaining all CA -MA Permits necessary to
install or construct (activity)
at (my property located at)
This certification is valid thru (date)
Property Owner Signature
q �
Date
400 Commerce Avenue, Morehead City, North Carolina 28557
Phone: [phone] FAX: [phone] Intemet: www.nccoastalmanagement.net
An Equal Opportunity 1 Affirmative Acton Employer — 50% Recycled 11 o% Post consumer Paper

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PI ER/MOORI NG PI LI NGS(BOATLI FT/BOATHOUSE)
I hereby certify that I own property adjacent to6t , . I 's
(Name of Property Owner)
property I ocated at © 0 p 2d h M o
(Lot, Block, Road,/etc.)
on C' a? — 4wf _ in %f L,9 � �, N.C.
(Waterbody). (Town and/or County)
He has descri bed to me, as shown below, the devel opment he is proposing at that I ocati on,
and, I have no obj ecti ons to his proposal . I understand that a pi er/mooring pi I i ngs/boatl i ft/boathouse
must be set back a mi ni mum di stance of fifteen feet (15') from my area of ri pari an access uni ess
waived by me.
I do not wish to waive the setback requirement.
I do wish to waivethat setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To befilled in by in ividual proposing development)
(Applicant Information)
Mai I i ng Address
POP, ,c 250
City/State/Zip
Tel ephone Number
'3•6-6-'7
Date
(Riparian Property Owner Information)
9gnature
6L iAIIL-1J
Print or Type Narr6
Telephone Number
31 & j'-1 .
Defte �'

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PI LI NGS/BOATLI FT/BOATHOUSE)
I hereby certify that I own property adjacent toC� 's
(Name of Property Owner)
Prey l ocated at 2 a ` , b! o z h ,' b o ►Z� or i vG ,
(Lot, Block, Road, etc.)
�.� ► '
on Bpsc,E So w n ��� � in �� , N.C.
(Waterbody). (Town and/or County)
He has descri bed to me, as shown below, the Bevel opn-ent he is proposing at that I ocati on,
and, I have nool jectionsto his proposal . I understand thatapier/mooring pilings/boatlift/boathouse
must. -be set back a minimum distance of fifteen feet (16) from my area of riparian access unless
waived by me.
I do -not -wish -to -waive. the setback requirement.
I do wish to waive that setback requirement.
DESCRI PTI ON AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To befilled in by individual proposing development)
JN
(Applicant Information)
�g
rling Ad:2-50
If
0
City/Rateo p
Telephone Number
,3.6-CS 1
Date
(Riparian Prope Owner Information)
Signature ; J
Print or Type Name
Telephone Number
Date

FOR (--
1100000 3 9 581I'
MUD BUCKET DREDGING INC
507 HEDRICK BLVD
MOREHEAD CITY, NC 28557-3045
PAY /
TO THE
ORDER OF (V C__.
BRANCH BANKING AND TRUST COMPANY5 I—/ ✓ / /
1.800-BANK BBT BBT.com
1:053 1011 2 11:0005 293 2 1834 lII'
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DATE '�' 2 `1
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3958
66-112/531
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