57305D - Blakenship

CAMA / ❑ DREDGE & FILL
'ENERAL PERMIT
New Modification uComplete Reissue ❑Partial Reissue
Previous permit #
Date previous permit issued
zed by the State of North Carolina, Department of Environment and Natural Resources 7f-I ' .[
I
�astal Resources Commission in an area of environmental concern pursuant to I SA NCAC
QRules attached.
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ng permit may �be�riegui ed y) OAK % SL. &V4 0 ❑ See note on back regarding River Basin r

Davis Canal
Town i
cd Street
Oak Isl

N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
r—
Date Ik N rL l , Z.O 1
Name of Property Owner Applying for Permit:
L- L, A- iU K I N S/ —1 P
Mailing Address: 14
�r,
N C-
I certify that I have authorized (agent) [\ % N N Y �kF U A7—TF— to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity) 7�?O A 7717 L-- ) )= T—
at (my property located at) / `�T 5 w ! A- c- 41
This certification is valid thru (date) (XkUE %5-,
GU�DJ 90/1 .
Property Owner Signature Date

Adj Prop Owner.jpg - Umail
Page 1 of
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERIMOORING PILINGSBOATLIFTBOATROUSE)
I hereby certify that I own property adjacent to f L `f y'N u JAU✓LrSAW
(j (Name of Property Owner)
property located at/.' 7 �J S 4L) / Ac m -r & ,
(Lot, Block, Road, etc.)
on A-v t c CAiu A t~ , in L9 4 K $ GRAV IL , N.C.
(Waterbody) (Town and/or County) Applicant's phoneN: Mailing Address: S W 1 v
!4%"IA.
G N uC- of $ Si6•S
He has described to me, as shown below, the development he is proposing at th tiort, and,1
have no objections to his proposal. I understand that a pier/mooring pilings / atl / boathouse
must be set back a minimum distance of fifteen feet (1S) from my area of riparian access unless
waived by me. (if you with to waive the se(back, you must initial the appropriate blank
below.)
I do not wish to waive
I SLO wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
_ (To be filled in by individual proposing development)-•- -
(Information for Property Owner Applying
for Permit)
Mailing Address !`
G,� Cr. '0;28k.r
City/StaterLip
Te It ne Numb r
(Riparian Property Owner Information)
' n
Signature
Print or Type Name
9�© 298 _. 08
r— Telephone Number

t CAMA AND DREDGE AND FILL ���r
GENERAL
PERMIT
as authorized by the State of North Carolina
Department of Environment, Health, and Natural Resources and the Coastal Res urces Commission
%. in an area of environmental concern pursuant to 15A NCAC 1 Q0 1 7_ d d
t Name )�AroQ fir- Ll-I IT '!o 6IPEY-3K1 DGCKS Phone Number 703 - b�l 07).
Dir-I L State zip 22 i S
xation (County, State Road, Water Body, etc.)
:CT DESCRIPTION I SKETCH f, / (SCALE: f - 20
,
o length
;th
length
e5 f _''
stance offshore
VT.
nnel dimensions
irds
dimensions -
T- O x I
-
-
it
iit is subject to compliance with this application, site r.
and attached general and specific conditions. Any '
of these terms may subiect the nermittee to a fine. �'���- --

Name of Individual Applying For Permit: � . �- r7` �q u A;�.lj�t,,���,
Address of Property: ` a 71
(Lot or Street #, Street or Road)
I hereby certify that I own property adjacent to the above -referenced -property. The individua
applying for this permit has described to me as shown on the attached drawing the development the,
are proposing. A description or drawing, with dimensions, should be provided with this letter.
- �Ive no objections to this proposal.
If you have objections to what is being proposed, please write the Division of Coasta
Management, 127 Cardinal Drive Extension, Wilmington, NC 28405 or call 910-395-3901
within 10 days of receipt of this notice. No response is considered the same as no objection i
you have been notified by Certified Mail.
WAIVER SECTIO
I understand that a pier, dock, mooring pilings, breakwater, boat house or boat lift must t
set bck a minimum distance of 15' from my area of riparian access - unless waived by me. (1
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 IS' setback requirement.
Sign Name Date
Print Name

Division of Coastal Mgt. Habitat Impact Computer Sheet
licant: �uftN ►1P, PONL� L i,4Q Permit #: S-730S
3ribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
id in your Habitat code sheet.
itat 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/c
temp impact
amount)
C W
Dredge ❑ Fill ❑ Both ❑ Other P/
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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 ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill 0 Both ❑ Other ❑

P R BLANKINSHIP
L D BLANKINSHIP
2509 VANDER13ILT AVE. PH. 833-3252
RALEIGH, NC 27607
D&V T(l N r� N
66_7704/2531 2548
DATE Q 2V
— 10�
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to ees' Credit Union®
State Eh;
Raleig Nort°Iina ,
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