55728_COOPER, AB_20100510

❑CAMA / ❑ DREDGE & FILL w J
GEN5Mocrfcation
RAL PERMIT revious permit #
❑New . ❑Complete Reissue ❑Partial Reissue ate 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.
Applicant Name ti �. L,�t Project Location: County ' �•
Address pf' Y ❑ Street Address/1State Road/ Lot #(s)
City , 'J� +_- /Srtate ZIP
Phone # ( ) j `Fax # ( ) Subdivision
Authorized Agent ! `�
Affected ❑ Cw ❑ EW M04W' ' ❑ ES
AEC(s): ElOEA ❑ HHF ElIH ElUBA
❑ PWS: ❑ FC:
❑ PTS
❑ N/A
ORW: yes / no PNA yes / no Crit.Hab. yes / no
City f 1 I
Phone # ('
Adj. Wtr. Body
Closest Maj. Wtr. Body_
ZIP
River Basin
Type of Project/ Activity �. j 1 r/ i1 i ti—Yrl Si--`! l !t _ . i�` l ' !� C (C d�, —17 i
(Scale: _)
Pier (dock) length
Platform(s)
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length
avg distance offshore
max distance offshore
Basin, channel
cubic yards
Boat ramp
Boathouse/\8 -- ift
Beach Bul
Other
iyi4- TF
Shoreline Length s.
SAV: not sure yes Nno
- -- -1 - -
Sandbags: not sure yes no
Moratorium: n/a yes
Photos: yes g .
Waiver Attached: yes ,no
A building permit may be required by: "� t' t�� 1` . `� !? �'" ❑ See note on back regarding River Basin rules.
1
Notes/ Special Conditions r S
Agent or Applicant Printed Name
Signature "Please read compliance statement on back of permit"
Application Fee(s) Check #
The time period requirement for this
A,. ..i ..a -J -' -
u a.. 1 WVIIIc"L a 3u3pCIIueu UIIIII 1L'J1-
2010, pursuant to Senate Bill 831. The
Permit officer's Signature ' effective date of e� pir ion for this
i ( permit is — —
Issuing Date ' Expiration Date
Local Planning Jurisdiction Rover File Name

s
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 howto complywith 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/ 1-8884RCOAST
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

Applicant:
Date:
Describe below the HABITAT disturbances for the application.
found in your Habitat code sheet.
All values should match the name, and units of measurement
Habitat Name
DISI URB fYPE
Choose One
TOTAL Sq. Ft.
(Applied for.
Disturbance total
includes any
anticipated
restoration or
temp impacts)
FINAL Sq. Ft.
(Anticipated final
disturbance.
Excludes any
restoration
and/or temp
impact amount)
TOTAL Feet
(Applied for.
Disturbance
total includes
any anticipated
restoration or
temp im acts)
FINAL Feet
(Anticipated final
disturbance.
Excludes any
restoration and/or
temp impact
amount
Dredge ❑ Fill ❑ Both ❑ Other
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
'252-802-2803-a8Z-1M1 COAST erg?* s ._s nod revised. �3i t

NCDENR row— RECEIVEr,
North . ar dra -)eoarrm8ni:Ot `nJrOi`rnen and Nah,ira1 Reis urCr;
Civision of cdastaa Management MAY � �011�
3everly E.avP3 i:Ierdue, governor James H, Gregson, Director Gee 'Freeman, ,'ecq pihhend CHY uCM
Date q o )0,_ j -- --
Applicant name H r6,z 'E a--
Mailinb Address To %�oy- ZSO
I certify that I have authorized (agent)to act on niy
behalf, for the purpose of applying for and obtaining all LAMA Permits necessary to
install or construct (activity) 'Z6 � '77c, ^-/1
at(location) P-orL4�,-5han2.c ) 306
This certification is valid thru (date)
Signature
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

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER111100R.iNG PILLNGSiBOATLIFTIBOATHOUSE)
i hereby certI y that 1 own property adjacent to A F) c� J RECEIVED
(Name of Property Owner) MAY 4 2010
property located at - �1c) _h S %i�!t ._.l.__ �_6 -- Morehead City ©CM
(Lot, Block, Road, etc.)
on. 4!f 4 --&,` , in &L_4--4 LC__ TSEIC.h N.C.
(Vdaterbody) (Town and/or County)
Applicant's phone #: 7 Zee '2-1G5 Mailing Address: 0 2T0
&44,md i
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
G S I do wish to waive that setback requirement.
------------------------------------------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
ivs�a �1 t_► �'k
F-4rF)#4,Cr o Lo g.&)1
L,:C4, poT
(Information for Property Owner Applying
for Permit)
1D BW 2s0
Mailing Address
City/StaeiZip
2( �:T6 -_)
Telcmhone Number
Signature Date
(Riparian Property Owner Information)
Signature
Gfcx, "iI/ Xz Z/ a 4 r-kr�
Print or Type Name
Telephone Number
Date

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FORA PIED111100R1NG PILING,SIBOATLIFTIBOA. THOUSE) RECEIVED
I hereby certify that I own property adjacent to �o� MAY 4 2010
(Name of Property Owner) Morehead City DCM
property located at _ P 1� 306...._-_
(Lot, Block, Road, etc.)
on , inP�L,e, fe'. , N. C.
(Waterbody) (Town and/or County)
Applicant's phone #: —7'24 Z!-�G5 Mailing Address: C) 30�0 Z 50
IkA!t4i jk�-& 6
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 (I T) 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)
L z�•!-� .�-r� � � ��C�--try
---------------------------------------------- +--------
(Information for Property Owner Applying
for Permit)
P. D SL"v -Z-5 o
Mailing Address
AAar%,J1 i'C'
City/ State/Zip
Teliphone Number
ignature Date
—1 ------------------------------------------------
(Riparian Property Owner Information)
Signature
mint or Type Nanie
Telephone Number
Date

MUD BUCKET DREDGING INC 35'7ZZ/ 5573L 4363
507 HEDRICK BLVD -13n 66-1121531
MOREHEAD CITY, NC 28557-3045 5c�) -1 '-�q j 15 5
Date N
Pay to the
order of
BRANCH BANKING AND TRUST COMPANY
1-800-BANKOBT BST.Com
M,
FOR
1100000113630 1:053101121111:00OS2932183L-111'
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