25508_ANDREWS, JIM_20000428

CAMA and DREDGE AND FILL 25508- C-
G E N E R A L
PERMIT
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 ���� , ; T
Groin Length
number
Bulkhead Length
max. distance offshore
Basin, channel dimensions
cubic yards
Boat ramp dimensions
Other
State
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
Phone Number
zip
(SCALE: )
applicant's signature
permit officer's signature
issuing date expiration date
attachments
application fee

FOLEY & FOLEY CONTRACTORS, INC.
PH. 252-636-2515
1810 OLD AIRPORT RD.
P.O. BOX 3482
NEW BERN, NC 28564
PAY
TO THE
ORDER OF.
DATE &- 7 9'Q
f
,
3204
66-1185/531
$ s0 m
DOLLARS 0 ��
&TRIANGLE 0ffim
AffiwBANK eW Bem, NC 28560 -------- m
FOR �
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- — --

Customer Job Requiretment Worksheet
Customer Name Date
Mailing Address aAUm(' Job site Address -
LIP( azet �c 45�0
Phone# ff' _ Fax#
Adjecent Property Owners
Left sideLejr..-,-sP(1(' � ev Right side Uua"ese_
tit
Date Mailed66/& Returned 6Date Mailed _MeturnedL/.) -0C,
Cert. Mailed Returned
State (CAMA)�
City LAZ &M
County
Fairfield Harbour
Bulkhead
Dock
Boatli
Jettie
Cert. Mailed Returned
Permit Required
Recieved
Recieved
Recieved
Recieved
Job Type
Boathouse
Jet Ski Lift
Ramp
Piling�t t

ADJACENT RIPARIAN PROPERTY OWNER
STATEMENT
(FOR A PIER/MOORING PILINGSIBOATLIFT/BOATIIOUSE
I hereby certify that I own property adjacent to �; K, 14tM'r0.t&' f 's
(Name of Property Owner)
Property located at
(Lot, Block,
d, etc.)
on � lower c� ". ,! � -.
(Waterbody) in �� � � ` 9) , N.C.
(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 (151) from my area
of riparian access unless waived by me.
I dnnot wish to waive the setback requirement.
I 134 wish to waive that setback requirement.
--------------------------------
------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT: ----------
'1 (To be filled in by individual proposing development)
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--------------
Signature
elA_C-C-1 3eLk
Print or Type Name
�;3-3 /3 3
Telephone Number
Date: izsc/

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(TOR A PIER/MOORING PILINGS/BOA7ZIFT/BOATHOUSE.)
I hereby certify that I own property adjacent to
(Name of Property Owner)
property located at
(Lot, Block, road, etc.)
on -ntrio-, in dJ sz 13Edw < , N.C.
(Waterbody) (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
piling s/boatlift/boathouse must be set back a minimum distance of fifteen feet (15') from my area
of riparian access unless waived by me.
_ 1 do not wish to waive the setback requirement.
I dq wish to waive that setback requirement.
- ----------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
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6� it,,
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------------------------------------------------------------------------------------------ _ ---------------------
Signature
lyow - CHc�r�ru�V
Print or Type Name
63S-6693Z
Telephone Number
Date: '- z/z z000