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Home My WebLink About74359D - BlanksCAMA / ❑ DREDGE & FILL NO. 74359 A B Co GENERAL PERMIT Previous permit # , (New ❑Modification ❑Complete Reissue []Partial Reissue Date previous permit issued As authorized by the State of North Carolina, Department of Environmental Quality and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC 0 11H _ ❑ Rules attached. Applicant Name �V+ -q f-y BL-Af/14S Project Location: County Ig1;MNSW I CK Address ,2 9.Z 9 PIRATP'_ 5Si, (t% T D'R Street Address/ State Road/ Lot #(s) City 51&?PLy State_ICC _ ZIP 29'46Z 5-AA A/>! csT'Fr—l=-r Phone # (") 34.9— 7140 E-Mail jr r r v filar+ ks 194 7B Subdivision N /A Authorized Agent W I « K1 cNAR c f c oM City '70..V VVY ZIP Z,• 4-G2- Affected XCW )(EW )<PTA ❑ ES ElPTS Phone # (91-o) 34*7 - 033 5 River Basin && M AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A Adj. Wtr. Bod AIWW nat ma nkn ❑ PWS: ORW: yes /� PNA yes / no Closest Maj. Wtr. 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A � g S 2019 IZ 9 Aol9 Issuing D toe Expiration Date Jul 23 19 12:24p p•S AGENT AUTHORIZATION FOR CAMA PERMIT APPUCATION Name of Property Owner Requesting Permit_ Jerry Blanks Mailing Address: Phone Number: Email Address: 2829 Pirate Shores Drive Supply NC 28462 804-349-7840 jerryblanksl947@gmafl.com I certify that I have authorized Will Richardson Agent l Contractor to act on my behalf, for the purpose of applying for and obtaining all CAMA permits necessary for the following proposed development: Installation of new floating dock and general Maint. on stationary dock at my property located at 2255 Shane St Supply NC 28462 in Brunswick County. ! furthermore certify that I am authorized to grant, and do in fact giant permission to Division of Coastal Management staff, the vocal Permit Officer and their agents to enter on the aforementioned lands in connection with evaluating information related to this permit application. Property Owner Information: Signature Annt or Type Name Title 7 1 23 1 %9 Date This certification is valid through 09 1 30 1 19 ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to Terry blanks s property located at 2255 Shane St (Name of Property Owner) AIWW (Address, Lot, Block, Road, etc.) on in SUPP Y N.C. (Vltaterbody) (City/Town and/or County) The applicant has described to me, as shown below, the development proposed at the above location. initial here _ J? % I have no objection k) this proposal. I have objections to this proposal. DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT (individual proposing development must fill in description below or attach a site drawing) Replacement of floating dock and general maintenance to stationary dock 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-) initial here �!% ) I do wsFr tt.iVB t�I` a##Gk tegtriet1: I do not wish to waive the 16 setback requirement. (Property Owner Information) (Adjacent Property Owner Informationl /�-7. Si turd M.13/.0A[Cr Print or Type Name AMA '�Xlc re r ar Mailing Address /VC aeyzg CitylS _- ( 89 - 7FZ/o Telephone Number Date - -- Sigrraiu- e SA-'O eN i2�,� Print or type Name -- 1'613 M._d/",4 2.- Mailing Address W A/C a2$Y/� City/StatP2i Tetephone Nujnber pate -- --------- ._ (Revised 6/18/2012) ADJACENT RIPARIAN PROPERTY QWNER STATEMENT I hereby certify that I own property adjacent to Jerry blanks s property located at 2255 Shane St (Name of Property Owner) on AIWW (Address, Lot, Blpck, Road, etc.) in supply , N. C. (Waterbody) (Cityirown and/or County) The applicant has described to me, as shown below, the development proposed at the above location. initial here I have no objection to this proposal.' I have objections to this proposal. DESCRIPTION ANDIOR DRAWING OF PROPOSED DEVELOPMENT (individual proposing development must flit in description below or attach a site drawing) Replacement of floating dock and general maintenance to stationary dock 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. (ff you wish to waive the setback, you must initial the appropriate blank below.) initial here -fix - I do wish to. waive flte 16 setback requirement: I do not wish to waive the 15' setback requirement. (Property Owner Information) (Adjacent Property Owner informationi Signature Print or Type Name Mailing Address City/ tast�/Zi�x' T s 9 7e$10 Telephone MUM r �a3�� Dare i? le K _)1u773,) Print or Type Name PU 60 x 3V Maiirn A dress �/.v AyC 828J. S`yo3yr ci ' tate/Zi9S" </9/7 Telephone Number _ _:� -- -- — (Revised 6/18/2012) 26304 SkOf S7 SCOPE OF WORK: REFLAGE EX15TIN& FLOA,TIN& DOCK IN SAME LOCATION loxib REPLACE -6 FILINC75 BECP" STATIONARY COOK GENERAL MAINT. oyviEpt. 61)PT NIA "A INC. �!00K 4WIFY -Z3 514k.9 ST SVPPLY W- 254 -40FT Y4ETLANM TS is F -11 3fT MOM w MEX TO tmu OP FLOAT �__---- .M KN i Date Received Date De osited Check From Name Nam. of Permlf Hclder Vendor Check Number Chock amount P.—it Number/Comments Rec.l t or Refund/Realloc.t d Columns Column? Column3 col—w C01umn5 C.IU-6 n7 Columnfl Columns 8/8/2019 8/8/2019 Bf8/2019 Lighthouse Marine Const/Darrell Emy __ :Will Richardson/Richardson Construction Will Richardson/Richardson Construction Morris & Truce Evans Morris Purdy Jerryftnks Coastal Bank d Trust BBST BBBT 2799 $ 200.00 GP #74608D GP #74528D GP #74359D JD ►ct. 8530 BB ret. 9138 BB rct. 9137 7503 $ 200.00 7502 200.00