53690_COOPER, AB_20090527

❑CAMA / ❑ DREDGE & FILL
r.E ERAL PERMIT
revious permit #
❑New ❑Modification ❑Complete Reissue ❑Partial Reissue ate previous permit issued
As authorized by the State of North Carolina, Department of Environment and Natural Resou pc,�s �t t
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
Q Rules attached.
Applicant Name A ("I i � ,,
Address'
City
: r �State : `..[' ZIP
_-
Phone # ( fit+— Fax # ( )
Authorized Agent?
Affected ❑ CW ❑ EW ❑ PTA [xs ❑ PTS
AEC(s): ❑ OEA ElHHF ❑ 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 J� ZIP
Phone # ( ) River Basin (,' t�J ( ; (; i
Adj. Wtr. Body -,1`—, (hat %man: unkn
Closest Maj. Wtr. Body
Type of Project/ Activity
(Scale: i )
Pier (dock) length
Platform(s) _ —..... _
Finger pier(s)
_
Groin length
number
Bulkhead/ Riprap length
avg distance offshore
max distance offshoreAA
Basin, channel'
cubic yards
i
Boat ramp—
Boathouse/ Boatlift
Beach Bulldozing
Other
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
i
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—
I
14
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_
3
V 1
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Ti
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rules.
❑ See note
on back regarding
River
Basin
-
(
Agent or Applicant Printed Name
Signature "Please read compliance statement on back of permit **
Application Fee(s) Check#
Permit Officer's Signature
Issuing Date Expiration Date
Local Marini ngJurisdiction Rover ile ame

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 I) 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.
(Serves: Carteret, Craven, Onslow -above
Raleigh, NC 27604
New River Inlet- and Pamlico Counties)
919-733-2293
Fax:[phone]
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

'1 lk
NCDENR %tj�y�North Carolina Department of Environment and Natural Resources � 009 i
Division of Coastal Management
Michael F. Easley, Govemor James H. Gregson, Director William G. Ross Jr., Secretary I.
Mich y,
D ate 3 ^ G - t3'1
Name of Property Owner Applying for Permit:
Mailing Address:
I certify that I have authorized (agent) 01 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)
E
Property Owner Signature
/ Date
.U.
400 Commerce Avenue, Morehead City, North Carolina 28557
Phone: [phone] FAX: [phone] \ Internet: www.nccoastalmanagement.net
An Equal Opportunity\ Affirmative Action Employer— 50%a Recycled \ 1o% Post consumer Paper

ADJACENT RI PARIAN PROPERTY OWNER STATEM ENT
FOR A PI ER/MOORI NG PI LI NGS(BOATLI FT/BOATHOUSE Z
y
I hereby certify that I own property adjacent to ! 's '9
I (Name of Property Owner) �®
property l ocated at 1 �(� o l d h M o gZc- o),- �",, ��
(Lot, Block, Road, etc.)
on.BD,,- c/ r� ---k- in % L.9► �� %�jE�c N.C.
(Waterbody), (Town and/or County)
He has described to me, as shown below, the development 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 ngstboatl i ft/boathouse
must beset back a minimum distance of fifteen feet (15) from my area of riparian access unless
waived by me.
12-A15-�'2
j3C-Aj zarAa—
I do not wish to waive the setback requirement.
I do wish to wave that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT -
(To befilled in by individual proposing development) f
(� Q`a vc
(Applicant Information)
�g
Mai I i ng Address
P o ►,,,, 25d
City/aate/Tap
Telephone Number
.3 , 6 `I
Date
(Riparian Property Owner Information)
9 gnature ; J
6L CN,%
Pr nt or Type Name
5� Z94/1 _2�G,Ks�
Telephone Number
31G,/ Off.
D&e "

ADJACENT RIPARIAN PROPERTY OWNER STATEM ENT
(FOR A PI ER/MOORI NG PI LI NGS(BOATLI FT/BOATHOUSE)
I hereby certify that I own property adjacent to(�� 1
(Name of Property Owner)
property l ocated at 0 2d h �' �' d ►Z� �c i'v ;,
(Lot, Block, Road, etc.)
on jB�vE So�N r� �...� ,in r� N.C.
(Waterbody), (Town and/or County)
He has descri bed to me, as shown bel ow, the devel opment he i s proposi ng at that I ocati on,
and, I have no obj ecti on to hi s proposal . I understand that a pi er/moori ng pi I i ngs/boad i ft/boathouse
must be set back a minimum distance of fifteen feet (16) from my area of riparian access unless
waived by me.
r
�Z� ISM 2
J 3 co
I do not wish -to waive thesetback requirement.
I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To befilled in by individual proposing development) C11 , S
Z.� o
A cx \
(Applicant Information)
�g
Mai I i ng Addres CC
Poi 2>o
City/State0p
Telephone Number
.3.6 -05 S'
Date
(Riparian Proper vwner information)
Signature
L LA
� dl
Print or 7}rpe Name
Telephone Number
Date

MR. ALFRED B. COOPER, JR. WACHOVIA BANK, NA 5680
BUSINESS ACCOUNT
P.O. BOX 250
ATLANTIC BEACH, NC 28512
66-21 /530 6/4/2009
PAY TO THE
ORDER OF NCDENR "800.00
Eiqht Hundred and 00/100"*****.****«*******,,*****************,****w,*********wk„**.***,,*****..**.***.�
DOLLARS
Security e features dulled.
N C D E N R �e,ars on back.
31013111 3Co�12-
5aoi 3C0�3
MEMO _dredging permits -North Shore _
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