NC Maritime Museum

®❑ CAMA / ❑ DREDGE & FILL No. 74466 A B C D
GENERAL PERMIT Previous permit#
❑New ❑Modification El Complete Reissue ❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality Ir , ;r �I1' / ( 1
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC - L 1/l i�
Rule attached
Applicant Name� i� �i ,. (-(j iprojeciLocation: County `
Address )h� , • , _ _ Street Address/ State Road/ Lot #(s)
City t _ State (2113t: 1
Phone # ( } I) �� I E-Mail Subdivision
Authorized Agent l' j \ 4 'Y l 1 l (4 t:1 City ')fA A` v L
❑CWW ❑PTA ❑ES ❑Prs Phone#�(` ��
Affected El OEA ❑ HHF LL IH ❑ UBA El NIA AEC(s): Adj. Wtr. Body
❑ PWS:
ORW: yes / no PNA yes /ono Closest Mal. Wtr. Body_
Type of Project/ Activity
_ Finger pier(s)
Groin length
■■C:rirA■!��
--pi number
avg distance
■0■■■®®m
■■■■■■■■■■■I
■����N■���I
-- - ■■■ ■■■■■■■I
max distance offshore ■■■■■■■■■■■1
Basin, channel ■■■■■■■■■■■1
cubic yards
■■■�■■■■■■■I
Boatramp
Boathouse/ Boatlift-
�lr�■■■■■■■■I
L1�1�■���n��l
• - ■a■��■■■■■
Shoreline Length -=
SAM not sure yes no
Moratorium: n/a yes -'
Photos: yes (( b iWaiver Attached: yes
A building permit maybe required by:
( Note Local Planning jurisdiction)
1 1
Notes/,Special Conditions
( c ,
Aedt gor Applicant Printed Name d ' - �• Permit0(�i
Signature ** Please read compliance statement on back of permit"'* Signatu{[e.
Application Fee(s) Check# Issuingb:
ZZ
ZIP i r.�
.a iverBasin
nat an /unkn
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(Scale: / r )
❑ See note on back regarding River Basin rules.

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
1 hereby certify that I own property adjacent to tJ C. ++•a_r:Ait+e i ky ,;e VL vV` 's
(Name of Property Owner)
property located at
(Address Block, Road, etc.)
on 4Ge.. C 4I� in J -a rnar , N.C.
(Waterbody) (CitylTown andlor County)
FIt-ha`s described to me, as shown below, the development proposed at the above
7
I have no objection to this proposal.
_____-- _.—.—.thave ohje�liocu�lolhis_propasal._. _..----
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
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05� 30' at
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WAIVER SECTION _... _.. _....
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set
back a minimum distance of 15' from my area of riparian access unless waived by me. (if you
wish to waive the setback, you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
1 do not wish to waive the 15' setback requirement.
(Property Owner Informa 'pn)
siz4ature
Print a�ypaName
Information)
Print oY.ype1yame J
GS7` -
J�lailirx�--�]ddress
AcroQr"
city2tte ip
Telephone Number
YS212yI'
Date ----
(Revised 611812012)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to N C MwSe\,L vO, s
(Name of Property Owner)
property located at
on
(Waterbody)
The applicant has described
locati n-os
(Address, Lot, Block, Road, etc.)
in _, N.C.
(City/Town and/or County)
to me, as shown below, the development proposed at the above
x S I have no objection to this proposal.
DESCRIPTION ANDlOR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must fill in description below or attach a site drawing)
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WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set
back a minimum distance of 15' from my area of riparian access unless waived by me. (If you
wish to waive the setback, you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
VI do not wish to waive the 15' setback requirement.
(Property Owner Infrmation)
t lT
(Adjacent Property Owner Information) S
�. VWajtnL SBA&
Sigti#3 63?CFMFecs
J. Dwayne Smith Assistant District Engineer
Print or Type Name
North Carolina Department of Transportation
Mailing Addregs
204 Q. Glen urnie New Bern, NC 28560
City/state/Zip
252-514-4716
Telephone Number
5/2/2019
Dale
(Revised 611812012)

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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to N e Mu.Se`& vA s
�/ (Name of Property Owner)
property located at '4z",
(Address Block, Road, etc.)
on N.C.
(Waterbody) (City/Town and/or County)
The applica t-has'described to me, as shown below, the development proposed at the above
locati
I have no objection to this proposal.
___— I_h�v� obje&tion�tathis_prAposaL_
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
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WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set
back a minimum distance of 15' from my area of riparian access unless waived by me. (If you
wish to waive the setback, you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Signature
Print or Type Name
Mailing Address
City/StatelZip
Telephone Number
Date
(Adjacent P7rope ner Information) C
an:%» �
gnatu e
Print qyr TTypef//oc.S lame
CGS
Ala, ddress
AciaQ�
City
Telephone Number
Date
vo
(Revised 611812012)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to tA eMa,,, .A- lg Ok IS
(Name of Property Owner)
property located at
(Address, Lot, Block, Road, etc.)
on , in N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
I have no objection to this proposal.
_ _�I hate objections to Ihis_pr_o.posaL ___
DESCRIPTION ANDIOR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
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is Cuxr-wA1 �
ercC D C!04- -- -Ty c&- ..lov"
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WAIVER SECTION _..
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set
back a minimum distance of 15' from my area of riparian access unless waived by me. (If you
wish to waive the setback, you must initial the appropriate blank below.)
1 do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information) (Adjacent Property Owner Information)
Signature Signature
Print or Type Name Print or Type Name
Mailing Address Mailing Address
City/state/Zip City/state/Zip
Telephone Number
Date
Telephone Number
Date
(Revised 611812012)