53692_COOPER, AB_20090527

1:1 CAMA / E DREbGE & FILL 1-01 it 10-115
r. GENgRAL PERMIT evious permit #
El".ew LiModification E]Complete Reissue El Partial Reissue iate previous permit issued
As authorized by the State of North Carolina, Department of Environment and Natural Rlources
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC
E Rules attached.
Applicant Name Project Location: County__
Address Street Address/ State Road/ Lot #(s)
City State ZIP
Phone # Fax # Subdivision
Authorized Agent
City
Affected1i Cw 0 EW D " 7PTA ES D PTS Phone # (—)—
AEC(s): [-] OEA Ll HHF El 1H El UBA D N/A Adj. Wtr. Body-
0 Pws: Ll FC:
ORW: yes / no PNA yes / no Crit.Hab. yes / no Closest Maj. Wtr. Body
ZIP
River Basin
(nat /man /unkn
Type of Project/ Activity
(Scale:
Pier (dock) length
Platform(s)_
Finger pier(s)
Groin length 9t
number
Bulkhead/ Riprap length_
avg distance offshore
max distance offshore
Basin, channel
cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
44-1
i
k
I
rT
j-T
&
V
NJ
41111,1
1
1
Shoreline Length'.
SAV: not sure yes no
Sandbags: not sure yes no
Moratorium: n/a yes no
Photos: yes no
Waiver Attached: yes no
A building permit may be required by:
Notes/ Special Conditions
See note on back regarding River Basin rules.
or Applicant Printed Name
Signature ** Please read compliance statement on back of permit
5& F0
Application Fee(s) Check #
PermitOfficer's Signature
Issuing Date Expiration bate
Local Plan n i ngJ u risdiction) 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 consistentwith 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/ I-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

t
' � 1
All,
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 3- ` C�9
Name of Property Owner Applying for Permit:
Mailing Address:
0
I certify that I have authorized (agent) I Lce� 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 11o% Post consumer Paper

s
RIPARIAN PROPERTY OWNER STATEMENT
ADJACENT
(FOR A PI ER/MOORI NG PI LI NGS00ATLI FT/BOATHOUSE) 1114� V°
hereby certify that I own property adjacent to(24' —rc ._r �q
(Name of Property Owner) �v
property l ocated at 1 12 N g z4 h 5' h 0 rz C- Oft iry I.
(Lot, Block, Road, etc.)
�s �� ► "
on �E So w � C,6 - � in �� N.C.
(Waterbody). (Town and/or County)
He has described to me, as shown bel ow, the devel opment he i s proposi ng at that 1 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 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)
s
I Ci c Yps x
(Applicant Information)
Mai l i ng Address
P 0 250
City/State'Zi p
Telephone Number
,3,6-bi'
Date
(Riparian PropeM uwner information)
Signature
Print or 7jpe Name
Telephone Number
Date

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PI ER/MOORI NG PI LI NGS(BOATLI FT/BOATHOUSE)
hereby certify that I own property adjacent toc.( +s �/V7
(Name of Property Owner)
property I ocated at I 2� h �� 1-1 a q-� D ^
(Lot, Block, Road, etc.)
[A - 5s � /
on j��c, So w r� 4Ca� in /� L.9 IL EA � 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 of j ecti ons to his proposal. I understand that a pi er/mooring pi I i ngstboatl i ft/boathouse
must be set back a minimum distance of fifteen fed (15') from my area of riparian access unless
waived by me.
13 -)t 20-,2
19 cu
I do not wish to waive the setback require Trent.
I do wish to waivethat setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To befilled in by individual proposing development)
(Applicant Information)
�g
Mai I i ng Address
PO`13o,,, 250
City/StateZp
Telephone Number
(Riparian Property Owner Information)
9grrature i
-- Pr nt or Type Name�
Telephone Number
j - io -6 17 off.
Date D& e -'
C7

MR. ALFRED B. COOPER, JR. WACHOVIA BANK, NA 5680 ,
BUSINESS ACCOUNT
P.O. BOX 250
ATLANTIC BEACH, NC 28512 r
66-21 /530 6/4/2009
PAYTO THE
ORDER OF NCDENR $ **800.00
Eight Hundred and 001100***************************************************************************************************
- DOLLARS
Secur¢y IeaWres
N C D EN R B included.
details on beck.
2-
5 poi 309
MEMO dredging permits - North Shore _.____ ____ _ _- _ _ _ qm
A ZE ATUR
11,00568011' 1:053000 2 L91: L05460 L8 26 L3311,