53338_COOPER, AB_20090309

❑ CAMA / ❑ DREDGE & FILL
GENERAL PERMIT Previous permit #
❑New` -]Modification ❑Complete Reissue El Partial 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 15A NCAC
Rules attached.
i -
Applicant Name
Address
_.
City
i
State
-f ZIP
Phone # ( )
' !'7
Fax # (
)
Authorized Agent
❑ CW
q EW
❑ PTA ❑ ES
❑ PTS
Affected
ElOEA
AEC(s):
❑ HHF
❑ IH ElUBA ElN/A
❑ PWS:
❑ FC:
ORW: yes / no
PNA
yes / no
Crit.Hab. yes / no
Project Location. County --
Street Address/ State Road/ Lot #(s)
Subdivision -_
City _ ZIP
Phone # ( ) River Basin C _
5
Adj. Wtr. Body ± (nat /man /unkn)
Closest Maj. Wtr. Body �� T
_ a
Type of Project/ Activity
Pier (dock) length
Platform(s)
Finger pier(s)
(Scale: f )
— — — i
Groin length
number
Bulkhead/ Riprap length
avg distance offshore
max distance offshore
Basin, channel ; ,' ,( �—
_
cubic yards 'y
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other—
�
i
�
I
j
—
-
I
-
—
,-
i
i
Shoreline Length
SAV: not sure yes no
i
Sandbags: not sure yes no
Moratorium: n/a yes no ~---�
Photos: yes no
I 1I� � II III
o — —- —
Waiver Attached: yes n.44
A building permit may be required by: [� See note on back regarding River Basin rule r
Notes/ Special Conditions
ent'or Applicant Printed Nam_ ee
Signature "Please read compliance statement on back of permit"
Application Fee(s) Check #
Permit Officer's Signature
IssuirigDate Expiration Date t
Local Planning Jurisdiction Rover File Name

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 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.
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

A
M.-
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Michael F. Easley, Governor James H. Gregson, Director William G. Ross Jr., Secretary
Date S -� cy
Name of Property Owner Applying for Permit:
Mailing Address:
J P,,, ,> ,�w/,-- &E-,� -
I certify that I have authorized (agent) 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)
Property 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

1
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 tor-C - �' : is
(Name of Property Owner)
property located at 2 0 2 old h b a ►Z� Q�`` i
(Lot, Block, Road, etc.)
on &5c c— So�H n co— � J in
L.9 ► L ���c N.C.
(Water.body) (Town and/or County)
He has desc ri bed to me, as shown below, the devel opment he is proposing at that I ocati on,
and, I have no cq ecti onto hi s proposal. I understand that a pi er/moori ng pi I i ngs(boatl i ft/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.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
' " (To befilled in by individual proposing development)
2�
(Applicant Information)
�g
Mai I i ng Address
P, O , -,, 250
Cityisaterzip
P"�� N r
Telephone Number
'3'(0�5'
Date
anon)
Signature I
Print or Type Name
2� 1- 8 44 '
Telephone Number
Date

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PI ER/MOORI NG PI LI NGSIBOATLI FT/BOATHOUSE)
I hereby certify that I own property adjacent to's
(Name of Property Owner)
prey I ocated at -2 o 2 N o rz4 h- j, o- Q i",&-
(Lot, Block, Road, etc.)
{s on %n� Lr9 v tE a9 N.C.
�E in
S��w � �a-� a-L. ,
(Waterbody) (Town and/or County)
H e has descri bed to me, as shown below, the devel opment he i s proposi ng at that I ocati on,
and, I have no obj ecti ons to hi s proposal. I understand that a pi er/moori ng pi I i ngs/boatl i ft/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 wi sh to waive the setback requi rement.
I do wish to waivethat setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To befilled in by individual proposing development)
2,LII
(Applicant Information)
_g
Altai I i ng Address
P 0�zso
Ci ty/state(zi p
Telephone Number
,3.6 -6 S,
Date
Sam �2� I'(��� v�©
k:)
(Riparian Property Owner Information)
2y / . 01 �4--
Signature J
Pr nt or Type Name
Telephone Number
3i&'-, ay.
Defte,

MUD BUCKET DREDGING, INC. 3658
PH. 252-241-1504 66-112/531
507 HEDRICK BLVD.
MOREHEAD CITY, NC 28557 ' / q
DATE
TO THE 1/�N s � Q� / rJ
ORDER OF 150
DOLLARS
BRANCH
TRUST7F COMPANY I-600--BANK BTBBT. �5 32V0% ,
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FOR
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