Causey, Willard

CAr1/IA / ❑;:DREDGE &
EN'ERAL' El
As autho`ried by the State of. North Carolir
lent of Environment and Natural Resources ✓
and the Coastal .Resou'rces Comm' sion i an area of environmental concern ursuant tb J5A NCAC
Applicant Name = AJi' 1
f ; �=
f. 7R ttached,..
Project Location: County .,
Address ; „ : ,
:
Street Address/ State Road/ Lot #(s)
Ci
State ZI P-W- ,
Phone # ( `) `
E-Maij� " ..
Subdivision
Authorized Agent
p w. z
City__.. ZIP ` A
Affected ' ❑ CW
A ❑ ES ❑ PTS
Phone # ( ) _ River Basin g
❑ OEA
AEC(s):
❑ HHF
❑ IH ❑ UBA ❑ N/A
Adj. Wtr. Body"
(nat a unkn
❑ PWS:'
ORW: y s
PNA
yes "�n
Closest Maj. Wtr. Body—
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Type of Project/
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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, certifythat 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 Resources. Contact the Division of Water Resources 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
Morehead City Headquarters
Washington District
400 Commerce Ave
943 Washington Square Mall
Morehead City, NC 28557
Washington, NC 27889
252-808-2808/ I-888-4RCOAST
252-946-6481
Fax: [phone]
Fax: [phone]
(Serves: Carteret, Craven, Onslow -
(Serves: Beaufort, Bertie, Hertford, Hyde,
North of New River Inlet- and Pamlico
Tyrrell and Washington Counties)
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)
Wilmington District
127 Cardinal Drive Ext.
Wilmington, NC 28405-3845
910-796-7215
Fax:[phone]
(Serves: Brunswick, New Hanover,
Onslow - South of New River Inlet -
and Pender Counties)
http://www.nccoastaimanagement.net/
Revised 08/27/ 14

CAMA / 11. DREDGE & FILL
�r A B D
ENERAL PERMIT Previous permit #
eve%; ❑Modification ❑Complete Reissue ❑Partial Reissue Date; previous permit issued
g"torazed by the State of North Carolina Department of Environment -and Nattaral Resources
he Caastal Resources Comm swn i an area of environmental concern, pursuant to'15A NCAC
q ttac
icnt Name
1 ;Protect Location; County
ess ` Street Address/ State Road/
�3 : ! i,t _ State ZII
E-Mail Subdivision
oriied Agent t. City ZIP
1ted . ❑ CW W PTA ❑ ES ElPTS Phone # (_) River Basin `
❑ OEA ❑ HHF ❑ IH ❑ USA ❑ N/A
�s) Adj. Wtr. Body nat a unkn
o PWs:
y PNA yes i Closest Maj. Mr. Body '^
e of Project/ Activity
(Scales )
(dock) length:
oTlatform(s)
sfm9 P.I.atform(s)
!n- length
number ..- C
idroMiONE�ARPao ii GMEw:
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nceoffshore ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■
■■■■■■■■■■■■■■■■■■■■■■!■■■■■■■■■■■■OMENS
.
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r
WDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Pat McCrory Braxton C. Davis
Governor Director
Date l - a o - 17
Applicant Name JJ d C (Cl- r d Ca u s c y
Mailing Address 3 n 8 rb x F f rx,, Pr
4L& -7
John E. Skvarla, III
Secretary
I certify that I have authorized (agent) (r,'c �f�cf to act on my behalf, for the
purpose of applying for and obtaining all CAMA Permits necessary to install or construct (activity)
L' A-{- f - + d6 c k o ") , at (location)
This certification is valid thru (date) _ / - L /F
Signature
400 Commerce Ave., Morehead City, NC 28557
Phone: [phone] FAX: [phone] Internet: www.nccoastalmanagement.net
An Equal Opportunity 1 Affirmafive Action Employer
FEB 0 9 2017
DCM- MHD CITY
NorthCarohna
Naturally

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
hereby certify that I own property adjacent to Y
's
p (Name of Property Owner)
property located at _ % ,D �Ce- ,,� e o q1
C (Address, Lot, Bloc oad, etc.)
on�/�4/ , in
7`15 N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the. development proposed at the above
location
have no objection to.this proposal.
have objections to this proposal.
DESCRIPTION -AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(Individual proposing development must fill-in descrip#Ion below or attach a site drawing)
WAIVER SECTION I
I understand that. a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set
back a minimum distance of 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.) ����'�ED
do Wsh_to waive the 15' setback requirement.
FEB 0 9Z017
I do not wish to waive the 15' setback requirement.
nr�m- rVIH®CITY
(Property Owner Information) (Adjacent Property Owner Information)
Sig '
J1.(Arol &U: c�
Date
Si
Print or Typ Name
M ' ng Addral9s
city%te2ip Telephone Number
�5a -aqD 3('317
Date —
(Revised 611812012) r