51170_OSBORNE, DAVID_20080702

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❑ CAMA / ❑ DREDGE & FILL L—/ I;
GENERAL PERMIT Previous permit#
❑lNew ❑Modification ❑Complete Reissue [--]Partial Reissue Date previous permit issued_
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 15A NCAC
Applicant Name
Address
City State
Phone # O Fax # ( )
Authorized Agent
❑ CW ❑ EW ❑ PTA
Affected
AEC(s):
❑ OEA ❑ HHF ❑ IH
❑ PWS: ❑ FC:
ORW:
yes / no PNA yes / no
ZIP
❑ ES ❑ PTS
❑ UBA ❑ N/A
Crit.Hab. yes / no
Rules attached.
Project Location: County
Street Address/ State Road/ Lot #(s)
Subdivision
City ZIP
Phone # ( } River Basin
Adj. Wtr. Body ! ; t Yl �\ f l nat man unkn
Closest Maj. Wtr. Body (", L f- I6" t Ire
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No
MEMMEMMEME
i1
Agent or Applicant Printed Name
Signature Please read compliance statement on back of permit ;
Application Fee(s) Check #
Permit Officer's Signature
L�
Issuing Date E piration Date _
M07a�Z/
Local Planning Jurisdiction Rover File Name

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Statement of Compliance and Consistency
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 or criminal 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 officer when the project is inspected for compliance. The
applicant certifies by signing this permit that 1) prior to undertaking any activities authorized by this permit, the applicant will
confer with appropriate local authorities to confirm that this project is consistent with the local land use plan and all local
ordinances, and 2) a written statement or certified mail return receipt has been obtained from the adjacent riparian
landowner(s) .
The State of North Carolina and the Division of Coastal Management, in issuing this permit under the best available
information and belief, certify that this project is consistent with the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
Tar - Pamlico River Basin Buffer Rules El Other:
Neuse River Basin Buffer Rules
If indicated on front of permit, your project is subject to the Environmental Management Commission's Buffer Rules for the
River Basin checked above due to its location within that River Basin. These buffer rules are enforced by the NC Division of
Water Quality. Contact: the Division of Water Quality at the Washington Regional Office (252-946-6481) or the Wilmington
Regional Office (910-796-7215) for more information on how to comply with these buffer rules.
Division of Coastal Management Offices
Raleigh Office Morehead City Headquarters
Mailing Address: 400 Commerce Ave
1638 Mail Service Center Morehead City, NC 28557
Raleigh, NC 27699-1638 252-808-2808/ 1-888ARCOAST
Location: Fax: [phone]
2728 Capital Blvd.
Raleigh, NC 27604
919-733-2293
Fax:[phone]
(Serves: Carteret, Craven, Onslow -above
New River Inlet- and Pamlico Counties)
Elizabeth City District
1367 U.S. 17 South
Elizabeth City, NC 27909
252-264-3901
Fax: [phone]
(Serves: Camden, Chowan, Currituck,
Dare, Gates, Pasquotank and Perquimans
Counties)
Washington District
943 Washington Square Mall
Washington, NC 27889
252-946-6481
Fax: [phone]
(Serves: Beaufort, Bertie, Hertford, Hyde,
Tyrrell and Washington Counties)
Wilmington District
127 Cardinal Drive Ext.
Wilmington, NC 28405-3845
910-796-7215
Fax: [phone]
(Serves: Brunswick, New Hanover,
Onslow -below New River Inlet- and
Pender Counties)
Revised 08/09/06

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to -DG( V a GS k cl� 's
(Name of Property Owner)
property located at Q �j 5 o Uk4l' P= ; Ve V Ir
(Lot, Block, Road, etc'..)
on ST oU��-�, , Ver in F)oau4uy 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.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(To fje fil ed in by individual proposing development)
- d
WA
(Applicant Information)
Mailing Address
Le -XI h14b n KI C, 2--7 -z-1 Z
City/Scat ip
3 3 6 - (o 'F7 - 0 -2-
Telephone Number
-2 <3 -o S
Date
(Riparian Property Owner Information)
Signature
A et ct c Q. /�, lit/ P e FPS
Print or Type Name
Telephone Number
/A y 3�, aoa8
Date
i

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to -1) &� V (' J 0 S 60 m e 's
(Name of Property Owner)
property located at 10 3 So V_ . -, \/ "' r
(Lot, Block, Road, etc.)
on S'D � R ( V e in R e- Q u— ) r + , 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.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(To be filled in,b}y individual proposing development)
6-1A �1
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g 4-- Q^e -A 1d1
1
---------------------------
(Applicant Information)
Mailing Address
l-2Xi ngT6n NC- 2%2012
City/State/4
3 3( —(e6-7— 034-2
Telephone Number
S -z0 —08
Date
(Riparian Property Owner Information)
r
gnatur
Print or Type Name
JS�-a'JI-ao�
Telephone Number
Date l �9 /0 9

DAVID W OSBORNE 2032
/531
KIM R OSBORNE BflANCH 70FMCH 37002
1882 Riverview Rd. Ext
Lexington, NC 27292 7 . Z C>9 Date
Pa to ,he / I $ 2- 0 0. O C)
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WACHOVIA.
Wachovia Bank, N.A. I C
wachovia.com ' � s /
For C A M L a k v r✓t ' Nr
i:053 LO L6 261: l0 L0085030958ll` 2032
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