25507_WEST, CARL_20000425

or
Applicant Name
Address
City
;I( (P�)
CAMA and DREDGE AND FILL _
G E N E R A L ((r ���,�~�
PERM 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
Project Location (County, State Road, Water Body, etc.)
State
Phone Number
Type of Project Activity i
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.
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zip
applicant's signature
permit officer's signature
TUC_-2
issuing date expiration date
attachments
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application fee

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FOLEY & FOLEY CONTRACTORS, INC.
PH. 252-636-2515
1810 OLD AIRPORT RD. 66-1185/531
P.O. BOX 3482
NEW BERN,NC 28564 DATE
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PAY $ /O. 0 O
TO THE
ORDER OF
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Customer Job Requiretment Worksheet
Customer Name CNA 1IA Date
Mailing Address2G O rJ(� . Job site Address �\,E
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Adjecent Property Owners
Left side, S `' Right side1
Date Mailed 3--t-_Returned,00
Cert. Mailed (10) Days
State (CAMA) �S
City
County
Fairfield Harbour
Bulkhead
Dock
Boatlift:,�
Date Mailed3-�Returned-�Ldw
Cert. Mailed t- G� (10) DaysCD
Permit Required
Recieved
Recieved
Recieved`
Recieved
Job Type
Boathouse q, 1.1 -
Jet Ski Lift
Repairing Dock Bulkhead

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ADJACENT RIPARIAN
PROPERTY OWNER STATEMENT
(rOR A PIERIMOORING PILINGSIBOATLIF rIBOATHOUSE)
I hereby certify that I own property adjacent to - 6, — -/ zt Z" � -� 's
(Name of Property Owner)
Property located at r.��1 � ,� �-.�ro � � , . ,�
(Lot, Block, Road, etc.)
on _ 1 ��- j� 1�I t�
' in, N.C.
(K'aterbody) (Town and/o 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.
--X— I & no wish to waive the setback requirement.
I -dQ wish to waive that setback requirement.
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Print or Type Name
Telephone Number
Date:

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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERIMOORING PILINGSIBOA7LIFTIBOA7110USE)
I hereby certify that I own property adjacent to ��/ zo?� l 's
(Name of Property Owner)
Property located at
(Lot, Block, Road, etc.)
onV � 1\� �— , in
, N.C.
(Waterbody)
(Town and/o 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 OQ wish to waive that setback requirement
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RIPTION R W G POSED DEVELOPMENT:
(To be filled in y divi pmeYa
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Signature
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Print or Type Name
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Telephone umber
Date:

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