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CAMA AND DREDGE(VD FILL
GENERAL 91 8629-e
PERMIT
as authorized by the State of North Carolina
Department of Environment, Health, and Natural Resources and the Coastal Resources Commission
in an area of environmental concern pursuant to 15A NCAC
Applicant Name "Yj ( - Phone Number
Address AII,X16*7,1-
City. 'S� State Zip
Project Location (County, State Road, Water Body, etc.)
Type of Project Activity _^?r 6 ��— + i.e.
PROJECT DESCRIPTION
SKETCH
(SCALE: )
Pier (dock) length
r
Groin length
number
Bulkhead length
d
max. distance offshore
i
Basin, channel dimensions
cubic yards
Boat ramp dimensions -
Other
T__
This permit is subject to compliance with this application, site
drawing and attached general and specific conditions, Any
4
violation of these terms may subject the permittee to a fine
applicant's signature
imprisonment or civil action; and may cause the permit to be-
_
come null and void.
This permit must be on the project site and accessible to the
permit officer's signature
permit officer when the project is inspected for compliance.
The applicant certifies by signing this permit that 1) this pro-
ject is consistent with the local land use plan and all local
issuing
date expiration date
ordinances, and 2) a written statement has been obtained from
adjacent riparian landowners certifying that they have no
attachments � 71 ,
/? 66
objections to the proposed work.
In issuing this permit the State of North Carolina certifies that
this project is consistent with the North Carolina Coastal application fee
Management Program.

1764
FOLEY & FOLEY CONTRACTORS, INC.
1810 OLD AIRPORT RD. PH. 252-636-2515
P.O. BOX 3482
NEW BERN, N.C. 28564
PAY
TO THE �.
ORDER OF_ I A' - �
J '
TRIANGLE
G �y 66-1185/531
DATE � �� / d"
6D'-1,6
DOLLARS 0 ^`
!-tee- Hwy. 70 Office
BANK New Bern, NC 28560
FOR 00GJ (10-1 00/ 0.4i ZS-G - � - -- -- - ---- --- - NP
1100000 L 76411' I:0 5 3 L L L8 5 21:09 3 L000 L 6011■

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0 (
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^t`fvr ycen.�
P`7� rl n r ' '} • '-S P # "''t �' ' , .�,w cif `�" Yks q .,•
I�hereby�ce i " at Ikown propertyjidiacent to' v ,e" s
+.�... . _ .. :. � -. ....
riame'of Landow er- proposing development
�F on _ t in/near, I,ot#':( of
Community Subdivision, if applicable
Tax Parcel SRL5,12�
. - r F 1 YAkP
om lete description of how to locate this property:
This proposed project, a �' , and the location has been described to me as
shown, in the drawing below and I have no objections to the proposal.
n For a Pier, check one of the Following:
I wish to waive the 15' minimum setback from my -riparian access..,., .•,,,,,;,,, ,.
✓ I do not wish to waive the 15' minimum^ setback requirement.
Draw the proposed^ structure in the space +provided below. List the siz'e'of the structure and
measured distances from the adjacent property lines, other structures on the property, and the
road, water,g`
• r
•e WO -Owner proposing the project, a copy is given to the a scent lanr tht cn d .

W
fi. h I
�rY,, � ass �t�,•�rr,;�.s� 7
74
£,.rFlSxiw iaCent RtpTartan proper Owner.�t�I�ment ` pn#
tdeAra w+:% y F! ` °_ ,. Y F qc .,. .dose .,. %'+ _' �.—ve �lll t,• ....
I hereby centfythat I;own property.
adjacent to s
Fmrar�-,.Name, of Landow er proposing development ... ... .. . _ _ ...
on t"` 1 r?''��� a l ^ in/near Lot#--L3 of', Nz�, It—k Vic' A"
:,Community Subdivision, if applicable '--
Tax Parcel #_:169Q - �I �� off SR 1 42�
Com lete description'of how to locate this property:
` t►-- ► t
This proposed project, a X—)C-K• Y1_ , and the location has been described to me as
shown in the drawing below and I have no objections to the proposal.
For a Pier, check one of the Following:
I wish to waive the 15' minimum setback from my riparian access.
I do net wish to waive the 15' minimum setback requirement.
Draw the proposed structure in the space provided below. List the size of the structure and
measured distances from the adjacent property lines, other structures on the property, and the
road, water, etc.
LO 3
After form is wmpletal by the landowner proposing the project, a copy is given to the adjacent landowners for their consent and
signa ;. The fonns are then returned,:along with a building plan and other applicable required infonnation; to the Building
Inspt is Ofhus for build ng permit application/prooessing.
Wx
Sig re 4r +�._1- I° 41s�q. Date
Y OR