25506_JOHNSON, MARK_20000425

CAMA and DREDGE AND FILL
G E N E R A L
PERMIT
i.
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 15 NCAC
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Applicant Name i <r" Phone Number
Address
CityState zip
Project Location (County, State Road, Water Body, etc.)
Type of Project Activity
PROJECT DESCRIPTION SKETCH
(SCALE:
Pier (dock) Length
(
r
} i'
-;%
€
Groin Length-�
number
Bulkhead Length
€
?
max. distance offshore
I
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Basin, channel dimensions —'-
cubic yards
Boat ramp dimensions -
I
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r
Other
-
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� y .
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, imprisonment 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 of-
ficer when the project is inspected for compliance. The applicant certi-
fies by signing this permit that 1) this project is consistent with the local
land use plan and all local ordinances, and 2) a written statement has
been obtained from adjacent riparian landowners certifying that they
have no 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 Management Program.
_ 1 applicant's signature
permit officer's signature
issuing date expiration date
attachments
application fee

-
___ , _--- 3193
FOLEY & FOLEY CONTRACTORS, INC.
PH. 252-636-2515
1810 OLD AIRPORT RD. 66-1185/531
P.O. BOX 3482
NEW BERN, NC 28564
DATE
PAY
TO THE
�1 ORDER OF _
�1 _ I �• I _ 1, J DOLLARS OPo m�
&TRIAN GLE offim
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BAN K New Bern, NC 28560
1100000 3 1113111 1 0 5 3 11 L8 '09 00 011'
NP

Customer Job Requiretment Worksheet
Customer Name����Date
Mailing Address)C)(jl �' P �Ina���Job site Address (Wj �-
Phone#� - � ) �0 Fax#
Left side
Adjecent Property Owners
Right side �P""
Date Mailed L -/-ODReturned& - -60 Date Maile Returned-00
Cert. Mailed (10) Days
State (CAMA)
City
County (J. e S
Fairfield Harbour
Cert. Mailed (10) Days
Permit Required
Recieved
Recieved
Recieved_
Recieved
Job Type
Bulkhead �� _ �) k�Boathouse_
Dock Jet Ski Lift
Boatlift Repairing Dock Bulkhead

:--�-. ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to -'La��of
� ��� ,s
(Name Property Owner)
property located at L
(Lot, Block, Road, etc.)
on �hP; �/Pr , in
(Waterbody) , N.C.
(Town andlo 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.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(To be filled in by individual proposing development)
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Signature
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Print or Type Name
,(' 37~ 355-6
Telephone Number
Date: / // ��± 2OCI�2

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to � 1n , , ,-" I
s
41 (Name of Property Owner)
property located at L
(Lot, BIock, Road, etc.) '
on �i P � ! �� 11 Pr-� , in � o
(Waterbody) , N.C.
(Town andlo 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.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(To be filled in by indi ' u proposing development) A_/
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�6O Gz ra �°�C�
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Signature
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Print or Type Name
�-3e
Telephone Number
Date: 41- -- / 2 -- d 0

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