87285A - Causey, Ronald and Jane

❑CAMA [IDREDGE & FILL NU 87285 ''A s C D
a°LN Previousp
!GENERAL PERMIT
Date previous ousp
3 � Date permit issued
�t❑New ❑Modification [I Complete Reissue ❑Partial Reissue
, As authorized by the State of North Carolina, Department of Environmental Quality and the Coastal Resources Commission in an area of environmental concern pursuant to:
15A NCAC ❑ Rules attached. General Permit Rules available at the following link: www.den.nc.yov/CAMArules
Applicant Name
±'
Authorized Agent i-,iff ' 0,., f,.., i,-,.
!_t C
Address
Project Location (County): 0 lln v..0 .-1
City State
ZIP
Street Address/State Road/Lot#(s) 0 f CS t,. r��c k
; to
Phone # ( )
Email
Subdivision ''=r•
City ZIP-i
51
Affected ❑ CW ❑ EW
❑ PTA
❑ ES
pTS
Adj. Wtr. Body
(ffat(fhan/unk)
AEC(s): ❑OEA ❑IHA
❑UW
SPIMA
❑PWS
Closest Maj. Wtr. Body
ORW: yes/no PNA: yes/no
Type of Project/ Activity
.I",_
(Scale: to IT .,_1
+Iu '
NOME
..
.C.■��....■ME
..■
..
;
Floating Platform(s)■
■■
■■N■
■
■■
ii■■�■■■■
■
■
�
�1
Finger pier(s)
C�
1111111�0:
al Platform area
Groin length/#
Bulkhead) Riprap length
Avg distance offshore
Max distance/ length
Cubic yards
Boat ramp
Beach Bulldozing
a■■■�■■■■
■■■i■�i■■n■■■■■■■
MI
��
i■
���
'NOME
C■
G
■
■
■�©�wi■iri�
OEM
■■
LILL
I
ON
so
Other
■H
■■
ME
■■■■■■■■M■■
■1��
{�■■■■
SAV observed: yes no
Moratorium: n/a yes no
Site Photos: yes no
A building permit/zoning permit may be required by:
Permit Conditions
❑ TAR/PAM/NEUSE/BUFFER (circle one)
See note on back regarding River Basin rules
❑ See additional notes/conditions on back
I AM AWARE OF STATUTES, CRC RULES AND CONDITIONS THAT APPLY TO THIS PROJECT AND REVIEWED COMPLIANCE STATEMENT. (Please Initial)
G. , ,/
Agent or Applicant PRINTED Name
Signature *'Please read compliance statement on back of permit'
itS,A..k rVPatitty
Application Feels) /,t�.r�a— Check q/Money Order
S I
1* S'Fd7StA ---� WY1 A16A 1 %1`11 Dick) A #83 a59A)
Permit Officer's PRINTED Name
Signature
Issuing bate Expiration Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: )oy\ �Ckc K e'
Mailing Address:
Phone Number:
Email Address:
IN
�Ja4,1—L,t, i6C a7 3
336�-- 3ciA- 34s_7
tr CCdU_SLs -'C
I certify that I have authorized L_ ii
LLC-
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:t?b
at my property located at ,OU J,iIE� 2syC
in L _County.
I furthermore certify that 1 am authorized to grant, and do in fact grant permission to
Division of Coastal Management staff, the Local Permit Officer and their agents to enter
on the aforementioned lands in connection with evaluating information related to this
permit application.
Property Owner Information:
Signa re
Print or Type Name
Title .
f/(l 2b Zf
Date
This certification is valid through I I

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
CERTIFIED MAIL - RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to lU be/ completed
Name of Property Owner:. CA (fg
Address of Property:
by owner or their agent)
C
Mailing Address of Owner: kA -1
Owner'semail: rCO Se) ?, &3&3:�,(J-�dtwner'sPhone#:
Agent's Name: ���` 4- Agent Phone#: Z,�Z" J37
Agent's Email: R �i9 5
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adjacent Property Owner)
I hereby certify that I own property adjacent to the above referenced property. The individual applying for this
permit has described to me, as shown on the attached drawing, the development they are proposing. A
description or drawing with dimensions must be provided with this letter.
4 1 DO NOT have objections to this proposal. I DO have objections to this proposal.
If you have objections to what is being proposed, you must notify the tv.c. utvisron or coastal
Management (DCM) in writing within 10 days of receipt of this notice. Correspondence should be
mailed to 401 S. Griffin St., Ste. 300, Elizabeth City, NC, 27909. DCM representatives can also be
contacted at [phone]. No response is considered the same as no objection if you have been
notified by Certified Mail.
WAIVER SECTION
I understand that any proposed pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or
groin must be set back a minimum distance of 15' from my area of riparian access unless waived by me
(this does not apply to bulkheads or riprap revetments). (If you wish to waive the setback, you must sign
the appropriate blank below.)
I DO wish to waive some/all of the 15' setback
Signature of Adjacent Riparian Property
Iffla
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner:
Typed/Printed name of ARPO:
Mailing Address of ARPO: (tom
ARPO's email: �&` ARPO's Phone#:
Date: *waiver is valid for up to one year from ARPO's Signature*
Revised July 2021

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed
Name of Property Owner:. L6 (d
by owner or their agent)
Address of Property: 2-oo 11(\te&
u Cl
Mailing Address of Owner: 9 _
Owner's email:ZS�E7LT (`Owner's Phone#:
Agent's Name: I ` d� �6 r`s w 15�v�r ^ Agent Phone#:
Agent's Email: �r�(5og�-slas
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adjacent Property Owner)
I hereby certify that I own property adjacent to the above referenced property. The individual applying for this
permit has described to me, as shown on the attached drawing, the development they are proposing. A
I DO NOT have objections to this proposal. I DO have objections to this proposal.
If you have objections to what is being proposed, you must notify the N.C. Division or Coastal
Management (DCM) in writing within 10 days of receipt of this notice. Correspondence should be
mailed to 401 S. Griffin St., Ste. 300, Elizabeth City, NC, 27909. DCM representatives can also be
contacted at [phone]. No response is considered the same as no objection if you have been
notified by Certified Mail.
WAIVER SECTION
I understand that any proposed pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or
groin must be set back a minimum distance of 15' from my area of riparian access unless waived by me
(this does not apply to bulkheads or riprap revetments). (If you wish to waive the setback, you must sign
the appropriate blank below.)
I DO wish to waive some/all of the 15' setback
Signature ofAdjacent Riparian Property Owner
-OR-
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner
Typed/Printed name of ARPO: f la r Ila 1 - �/'��an � n'
Mailing Address ofARPO: '� prjndee Of`, �den�on f Nrcr a7�i3�
ARPO's email: Ayari QrWcrh1011-(,4(ARPO's Phone#: Cep I 2 D3- 733-gl6(a
Date: .J 16 _*waiver is valid for up to one year from ARPO's Signature*
Revised July 2021