63121_Bill Osborn_20181002

CAMA./ ❑DREDGE &'FILL D fp3I a -No.,- 72467
GENERAL PERMIT Previous permit#!+�/JAC D 4`
New ' ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued mil/ '
r^ te of North'Carolina, Department of Environmental Quality
As authorized by the Sta/
and the Coastal Resources Commissiori in.an-area of environmental concern pursuant to 15A NCAC
�' � ;�lesattached.
Proect Location:.Coun '
Applicant' Name (`` / , j tY r ,. _
�� . ,01
"Address,�� ' . '� 1 /` ' v� Street Address/ State Road* ('Lot Lot (s)��� .
City: )_ l dl State ZlP
- .Phone'#) �It�'E-Mail Subdivision
Authorize' " ' (%�, �O �S% G�,�1 (' City �%G� ZIP l
'CW EW PTA ES TS Phone# River Basin Gil ' �;• . .' Affected. / ' ( )
❑ OEA _ ElHHF ❑ IH .: ElUBA . ❑ N/A
AEC(s): Adj. Wtr. Body le '7 I'/ nat�man unkn
_ ❑ Pws: Closest Maj. Wtr. Body /J%�
ORW: yes./ 1no? PNA yes / E
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Agent or pplicant Printed Name '
Signature\ PPI"ease read compliance statement on back of permit
Ap ication Fee(s) Check #
Signature
Issuing Date
ExpirationYdate

ADJACENT RIPARIAN PROPERYY NP-R SYATEi1fiENY
I hereby certify that I own property adjacent to 1`n ►6N Aci, D 6-t--13Wz; ,s
(Name of Propeuly owner)
property located at Z- S Q � (7�'� 0�>
(Address, Lot, Block, Road, etc.)
on �� i �Zl�' f3� y , in ig(i�6- 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 have objections to this proposal.
DESCRIPTIONAND/OR DRAWING OF PROPOSED DEVELOPMENT
(7ndividual propozing development must fill in description below or aftch a site drawing)
WAIVER SECTION!
I understand that a pier, dock, mooring pilings, boat ramp, 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.)
OU4�, I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property user Information) (Adjacent Property Owner Information)
Signature 5 Ar oib u re- Signature*
Print or Type Name Print or
V<-v
Mailing Address �� CIO
7 8 I o t3t� AVC-NI , gG
��ryi�rareiup ..,.�, W-,q, �
9sa-13Y3-7S�-{9 `-8
Telephone .Number/email address Telephone Number/email ad
to-/-18 C1'(Z-31 zots
Date Date*
(Revised Aug. 2014)
"Valid for one calendar year after signature*

AD� T RIPARIAN PROPERTY OWNER SYAYEf�lE�7
I hereby certify that I own property adjacent to —IV,, C- 's
— - . . .IN a of,l.ro sty Ownlar)
property located -at '
(Address, Lot Bloc Road' et .
CJ C N.C.
on (@�laterb y) , in (city/Town ancolor Count
The applicant has described to me, as shown below, the development proposed at the above
locati
I have no, objection to this proposal.
I have objections to this proposal.
DESCRIPTION ANID/Olk DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing] development must fIll in descriptlon below or easch a sHe drawing)
WAIVER SECTION!
I -understand that a pier, dock, mooring pilings, boat ramp, 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.)
• }` 3 i
I do wish to waive the 15' setback requirement.
do not wish to waive the 15' setback requirement.
( ropert Owner In ®51t:1rn)ation)
Signature O'Sf?
Print or Type Name
(Adjacent Property Owner Information)
or
Mailin Address m aaress �-
g /`%C a�8J0 ave^
city%StateMp C' State/Zi
:.52-9�rs-7sy9 -—�'lV5•-73c��
Telephone .Number/email address ephone Number/emailrss
_to— 1-18 �" I`�' -��r l
Date ^ Date*
(Revised Aug. 2014)
*Valid for one calendar year after signature•

NC Division of Coastal Mgt. Habitat Impact Computer Sheet
Applicant:
Date: A
General Permit #: �zz�� r
Describe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
found in your Habitat code sheet.
Habitat Name
DISTURB TYPE
Choose One
TOTAL Sq. Ft.
(Applied for.
Disturbance total
includes any
anticipated
restoration or
temp impacts)
FINAL Sq. Ft.
(Anticipated final
disturbance.
Excludes any
restoration
and/or temp
impact amount)
TOTAL Feet
(Applied for.
Disturbance
total includes
any anticipated
restoration or
temp impacts)
FINAL Feet
(Anticipated final
disturbance.
Excludes any
restoration and/or
temp impact
amount)
Dredge ❑ Fill ❑ Both ❑ OtherA
Dredge ❑ Fill ❑ Bath ❑ Other
Dredge ❑ 'Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ . Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
252-808-2808 :: 1.888-4RCOAST :: www.nccoastaimanagement.net revised: 02/03/10