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CAMA and DREDGE AND FILL
IM
G E N E R A L
P E R M I T
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
Applicant Name
Address
City
Project Location (County, State Road, Water Body, etc.)
Type of Project Activity
PROJECT DESCRIPTION SKETCH
Pier (dock) Length 7
Groin Length
number
Bulkhead Length
max. distance offshore
Basin, channel dimensions
cubic yards
Boat ramp dimensions
Other
Phone Number.
State Zip
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.
(SCALE:
applicant's signature
permit officer's signature
issuing date expiration date
attachments
application fee

05/23/00 09:45 FAX
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Customer Name J�) pate_ S:3�CC
Customer Job Requiretment Worksheet
Mailing Address Job site Address-9n--� Cz y' 4
L Oil _ �l 6 L V
Phone Pam_Lq _I �—
Adjecent Property Owners
Left side Right side
Date Mailed
Returned
Date Mailed
keturnedL-q_oo
Cert, Mailed
Returned
Cert_ Mailed
Returned
Permit Required
State (CAMA) `mil Recieved
City Recieved
County
Fairfield Harbour
Bulkhead
Dock- LI �-
Boatlift
Jettie
Recieved
Recieved
Job Type
Boathouse,
Jet Ski Lift
Ramp
Piun `

05/23/00 09:45 FAX Z 02
. .•r— "JACWT RIPARIAN MOPMTY OWNER STAMZEN'I'
(FOR A PIERIMOORING PHJNGS1B0A2UFT/B0ATH0USE
)
I hereby certify that I own property adjacent to L � 1.-iAA:Ta"e _c) 's
(Name of Property Owner)
property located at
(Lot, Block, Road, etc.)
on F= r 14 w ►4i1rit uoQ7� in.s.-� �1_('y P.t� i
Materbody) (Town and/or County)
He has described to me, as shown below, the development he is proposing at that
location, and, I have na, objections to his proposal. I understand that a pier/mooring
pi ingVbmfflftfbaathouse 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 d4 wish to waive that setback requirement.
DESCREMON AND/OR DRAWING OF PROPOSED DEVEMPMENT:
(To be filled is by individual proposing development)
Signature
!�/:l/ a,1-2 -7 7; /few
Print or Type Name --1—
Telephone Number
Date:

05/25/00 0 9 : 45 F.tX Z 03
l ADJACENT RIPARIAN PROPERTY OWNM STA'T'EMF.W
(FOR A PIER/MOORING P&mGslaoA7up7lRoAmovsE)
I hereby certify that I own property adjacent to L 1►-s Ay cAcq () -s
(Name of Property Owner)
property located at
(Lot, Block, Road, etc.)
on 14. u) 4�. �, �•, , in Uot F,:) lekt-1 I ('LdyP , N.C.
(Waterbody) �W (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/boattift/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 d2 wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT;
(To be filled in by individual proposing development)
2f� � �9�
lure
Print or Type Name
Telephone Number
Date: G

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3323
FOLEY & FOLEY CONTRACTORS, INC.
PH. 252-636-2515 66-1185/531
1810 OLD AIRPORT RD.
i' P.O. BOX 3482
NEW BERN, NC 28564 DATE
PAY
-' TO THE
ORDER OFfft,•u,�m� DOLLARS 8 w
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I Jwy. 70 OfficeC-L)
in"
&XBANKNew Bern, NC 285608M'
FOR $ ■ n■ �:0531 5 21:093 L000 L601n 00003323 __'•\1155L•YW!!!!l:'•�—_-..•\lUN1U01//­_­.. lf\l4TAL@V!/l' ._--.,aQoY[9A,"._