53015_COOPER, AB_20081217

❑ CAMA / ❑ DREDGE & FILL ,7
GENERAL PERMIT
n
❑New ❑Modification ❑Complete Reissue El Partial Reissue (
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
� 1
Pr ious permit #
Date previous permit issued
❑ Rules attached.
Applicant Name
/ -_ • �_ r
.
Project Location: County
Address
tTr`s {- E k , ; E
Street Address/ State Road/ Lot #(s)
City �- ./l
States ZIP fi
Phone #
# O
Subdivision
-
AuthorizedAgent
City
ZIP
❑ CW
EJEW JPTA qFs' El
Phone # ( )
River Basin , ,
Affected
OEA
AEC(s):
❑ HHF ❑ IH ❑ UBA ❑ N/A
Adj. Wtr. Body
J < _- (rat 1-an /unkr)
1 PWS:
ElFC:%
ORW: yes / no
PNA yes / no Crit.11i yes / no
Closest Maj. Wtr. Body
)4
Type of Project/ Activity
(Scale:
)
14
Pier (dock) length
Platt
Finger pier(s)
Groin
Boat
Othe
Shor
SAV:
Phot
A building permit may be required by:
Notes/ Special Conditions
— See note on back regarding
River
Basin
rules.
orm(s)
length
number
_ -• -
head/ Riprap length
avg distance offshore
max distance offshore
FT -
channel
cubic yards `�`.:- _
ramp
•- -.. ,. , , --
� I
Boatlift
h Bulldozing
i I II I
eline Length
not sure yes no
I I I
no
h
not sure es i
y
atorium: n/a yes no
os: yes no
Agent or Applicant Printed Name
Signature ** Please read compliance statement on back of permit **
Application Fee(s) Check #
Permit Officer's Signature
Issuingbate `--Ex iratio Date
x-
Local Planning Jurisdiction Roder File Namd
Agent or Applicant Printed Name
Signature ** Please read compliance statement on back of permit **
Application Fee(s) Check #
Permit Officer's Signature
Issuingbate `--Ex iratio Date
x-
Local Planning Jurisdiction Roder File Namd

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

A��
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management Aore. t_-;jt�,j r
Michael F. Easley, Governor James H. Gregson, Director William G. Ross Jr., Secretary
Date 1 —Z , 1 a'
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 CAMA Permits necessary to
install or construct (activity)
at (my property located at) `2-0 3
This certification is valid thru (date)
Property Owner Signature
i?• 1-0' aK
Date
400 Commerce Avenue, Morehead City, North Carolina 28557
Phone: [phone] FAX: [phone] Internet: www.nccoastaImanagement.net
An Equal Opportunity1 Affirmative Action Employer — 50% Recycled 110% Post Consumer Paper

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOOREVG PIL17VGSIBOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to HL� N �� E 1'� �� 1:.: 's
a
(Name of Property Owner)
property located at - V NO 1L'�- b ww Z lYl 4 Q
(Lot, Block, Road, etc.)
onv�Scyw p �� c�r;C a Cr , in J-t-� �-- tC �� �i C. F'� , N.C.
(Waterbody) (Town and/or County)
He has described to me',as shown below, the development he is proposing at that location,
and, I have no objections" s_roposal. I understand that a pier/mooring pilings/boatlift/boathouse
must be set back a minimuIIlttl'1Stance of fifteen feet (15') from my area of riparian access unless
waived by me.
I do not wish to waive the setback requirement.
I do wish to waiv4.ffiat setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT: `
(To be filled in by individual proposing development) l�
3aX2a)c31 ,11,Z10okZ-tr �� cG•�os
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2' 2
6
(Information for Property Owner Applying
for Permit)
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Mailing Address
W dso 'o
City/State/Zip
2 45 z 2q
Telephone Number
N, 2-) 199
GI?q-o
(Riparian Proper weer Information)
Signature
Print or Type Name
Z5Z -'�
Telephone Number
)z-- )I - USA
Date
Signature Date

41
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERIMOORING PILINGSBOATLIFTBOATHO USE)
I hereby certify'that I own property adjacent to H L-wm �Q E Y� K.. is
(Name of Property Owner)
property located at 2* , y3 1 Y O)L+ h �j hot M 4 Q
(Lot, Block, Road, etc.)
5 `
onyL , in 41 N-C.
(Waterbody) (Town and/or County)
He has described to 00 as shown below, the development he is proposing at that location,
and, I have no objections to Y sTroposal. I understand that a pier/mooring pilings/boatlift/boathouse
must be set back a minimunQistance of fifteen feet (15') from my area of riparian access unless
waived by me. H"
I do not wish tor.waive the setback requirement.
I do wish to waive,tliat setback requirement
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT: ( 6 r
(To be filled in by individual proposing development) ]� <X
Z��ti 34. 2r6N
3D,X 2a)c —Z t o0',Zq
L) 4--4--
2' 2 �
1✓�1 , 54 iuS IDoe-
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30
(Information for Property Owner Applying
for Permit)
-3A ] ��.��w5��rry TZO g-10
Mailing Address
bid so') , N. L , 2-) '�q 6
City/State/Zip
245 z -zq I G,? q-o
Telephone Number
(Riparian Property Owner Information)
Signature
L E/y/t! 31 AyS 1, rE/Z--
Print or Type Name
-- 72 , - 24 &,57-
Telephone Number
Z --ii._
Date
Signature Date

MR. ALFRED B. COOPER, JR.
BUSINESS ACCOUNT
P.O. BOX 250
ATLANTIC BEACH, NC 28512
PAY TO THE
ORDER OF NCDENR
WACHOVIA BANK, NA 5469
66-21 /530 1 /5/2009
$ **1,200.00
One Thousand Two Hundred and OOI100"""'"*""DOLLARS
®Iecunry features
t included.
Details w back.
NCDENR
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