40075_BAYLISS, TOM_20041102

CAMA / S DREDGE & FILL
, P975
GENERAL PERMIT
I, ' C
P
Previous permit # / `�
DiNew Modification —]Complete Reissue D'Partial Reissue
Date previous permit issued
j
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
/ 9
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1 `/ h-V
D Rules attached.
Applicant Name !J�
Project Location:
County
Address ' '� t' c' (•'^`�
j
Street Address/ State Road/ Lot #(s)
City Pe-L ; r. State_ ZIP
Phone # (,) / 3 Fax # ( )
Subdivision
o e
Authorized Agent �'" f w " '
City / UG` ''
`' _ZIP
- Cw L4& H-P`TA CES ❑PITS
Affected
Phone # ( )
River Basin
-' OEA ❑ HHF C IH El USA El NIA
AEC(s):
Adj. Wtr. Body
,
n- f`�'1' - (natJma/unkn)
_,
FpWs: ❑FC:
ORW: yes / no PNA yes / no') Crit. Hab. yes / no
Closest Maj. Wtr. Body
Type of Project/ Activity
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/ Boatlift? -
- --'—`- --
Beach Bulldozing
Other
f-
Shoreline Length
SAV: not sure yes no.
Sandbags: not sure yes no
Moratorium: n/a yes no
Photos: yes no
Waiver Attached: ryes no
A building permit may be required by:
Notes/ Special Conditions
i
(Scale: /t ,A `� )
r
_' See note on back regarding River Basin rules.
Agent or Applicant —Prided Name 1 Permit Officer's Signature
Signature `-- "Fslease read compliance statement on back oipermit *
Application Fee(s) Check #
Issuing Date
Local Planning Jurisdiction
Expiration Date
p 11 b))- ) 6"4
Rover File Name

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
landowners).
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:
�euse
amlico River Basin Buffer Rules _ !Other:
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 (910-395-3900) for more information on how to comply with thesebuffer rules.
Division of Coastal Management Offices
Central Office
Mailing Address:
1638 Mail Service Center
Raleigh, NC 27699-1638
Location:
Parker -Lincoln Building
2728 Capital Blvd.
Raleigh, NC 27604
919-733-2293 / 1-888-4RCOAST
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)
Morehead City District
151-B Hwy. 24
Hestron Plaza II
Morehead City, NC 28557
202-808-2808
Fax: [phone]
(Serves: Carteret, Craven, Onslow -above
New River Inlet- and Pamlico 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
910-395-3900
Fax:[phone]
(Serves: Brunswick, New Hanover,
Onslow -below New River Inlet- and
Pender Counties)
www.nccoastalmanagement.net
Revised 10/05/01

FOLEY & FOLEY CONTRACTORS INC.
PH [phone]
1810 OLD AIRPORT RD.
NEW BERN, NC 28562
PAY
TO THE
ORDER
I �1
1289
Al66-1)21531
0901
DATE I
$104�
�4m42---1 DOLLARS
BLU ELITE BUSINESS
BRANCH BANKING AND TRUST COMPANY
T'41
BERN, NORTH CAROOLIN�A
I FOR �''✓ r ��11075 nr
11.00128911' i:0S3L0LL20:S2900S2L40118
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To: Mark Hardiman (Cama)
Fax#: [phone]
Date: October 22, 2004
Page#: 3
From: Foley & Foley (Sandy)
Phone#: [phone]
Customer Work Sheet
Customer Name: Tom Bayliss Date: October 22, 2004
Mailing Address: 3201 River Ln New Bern, NC 28560
Job Address: Same Phone: [phone]
Adjacent Property Owners
Left Side: Bayliss Right Side: Alaxander
Bulkhead
Dock/Walkway
Platform end of dock.
Boathouse
Boatlift/ et ski 101000#
Piling
Ramp/Jetty
Dredge
Rip Rap'
Job Type Description

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERIMOORING PILINGSBOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to ) o is
(Name of property owner)
property located at 3 20 1
(Lot, block, road, etc.)
on 1 Rra� l 12 ter, h ' in A 13�rgN, c,to ram. N.C.
(Water body) (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 to his proposal. 1 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.
I do not wish to waive the setback requirement.
I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(to be filled in by individual proposing development)
a o 0
Nuur C)y31iy t' o
Foley & Foley Contractors, Inc.
Phone#: [phone] Si
Fax#: [phone] /
cA �7 A,117 (�01
or Tvbe Name
elephone Number and Date

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSBOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to J ©vn /,'t 1 's
(Name of property owner)
property located at 3,?o I 4�' J F w,
(Lot, block, road, etc.)
on >"• �j r-vr , in to F,4) 13,6f ip CP-gvF - , N.C.
(Water body) (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 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.
I do not wish to waive the setback requirement.
I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(to be filled in by individual proposing development)
� 0 6
Foley & Foley Contractors, Inc.
Phone#: [phone]
Fax#: [phone]
bign�ure� Vr
Print or Type Name
2 2 5/N DA/ -3 1�/221 Zll
Telephone Number and Date