53959D - Blankenship

P1 AMA / DREDGE & FILL
E N E RAL PERMIT Previous permit #
Crew Modification []Complete Reissue El Partial Reissue Date previous permit issued
orized by the State of North Carolina, Department of Environment and Natural Resources
Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC ,61. 22 GG
(mules attached.
nt Name ---'/2 V, .L1 Project Location: County_,!,, Sz✓! C I(
>s l t' a .j` %� trjS e f/ /V P "'e Street Address/ State Road/ Lot #(s) s'fjirJ �
�"42 aL z Stater! _ ZIP 27Y42
# (910)2 219 89ZFax # ( ) Subdivision
•ized Agent
d ❑ CW QEW ❑•iLTA f]E5 ❑ PTS
❑ OEA ❑ HHF ❑ IH ❑ USA ❑ N/A
PWS: LIFO
City
ZIP
Phone # ( ) River Basin
Lo � 7�
Adj. Wtr. Body �iA t e � * /C I �l2 nat
yes / no PNA rs / no Crit.Hab. yes / no Closest Mal. Wtr. Body
of Project/ Activity ;��, v A 2 ! ex c
(Scale:
w
lock) length � -Ic r rEW
pier(s)
length
camber
ead/ Riprap length
ivg distance offshore
nax distance offshore
channel
:ubic yards
amp
Ouse/ Boatlift
Bulldozing
ine Length _57__
not sure yes
no
ags: not sure yes'
chum: n/a yes
yes
r Attached-: 4 '
no
ding permit maybe required by: �� u,�SGu if �� CDds ❑ See note on back regarding River Basin

Hed //W;.
CERTIFIED MAIL — RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
Name of Property Owner:Q
Address of Property: �L� % C� � 5,f j.� _ we_&
(Lot or Street u, Street or koad, City & Coti,.ay'
Applicant's phone #: ci �r�� L Mailing Address:
I hereby certify that I own property adjacent to the above referenced property. The individual applying for this pe
has described to me as shown on the attached drawing the development they are proposing. A description of drav
with dimensions, must be provided with this letter.
I have no objections to this proposal. I have objections to this proposal.
If you have objections to what is being proposed, you must notify the Division of Coastal Management (DC
in writing within 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive
Wilmington, NC 28405-3845. DCM representatives can also be contacted at [phone]. No response is
considered the same as no objection if you have been notified by Certified Mail
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, or lift must be set back a minimum distanc
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' set back requirement.
I do not wish to waive the 15' set back requirement.
(Pro erty Owner Information)
Signature
DAVd., bl- At/Qdk01!sA#
Print or Type Name
t 39-S' Ausse 11 lkwelf0 s iv
(Riparian Property Owner Information)
Signature
R r4 ld 1-��i
Print or Type Name
Mailing Address
Mailing Address

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
_ FOR A PMKMOORDVG PILINGSBOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to DAVI blqd �'s
(Name of Property Owne
property located at Ay� GSA SA AftyP ff/ 2115
(I.ot, Block, Road, etc.)
4 10011
on C (92 ►1 4t 40hd,& in 6(ukwicf, . N.C.
(Waterbody) (Town and/or County)
Applicant's phone #: Mailing Address: l 7$r fuss-agtW .l'Y RS
He has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal. I understand that a pier/mooring pilings / boatliflt / boathouse
must be set back a minimum distance of fifteen feet (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 not wish to -waive
X�C do wish to waive that setback requirement.
---------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by in4vidual proposing development)
(Information for Property Owner Applying (Riparian Property Owner I ormation)
for Permit)
AS-fi // ".
*-Kovs-v A1AA_f'a,_ z
Maiiing Address Signature

rAS40-

ILANKENSHIP CONSTRUCTION INC
PH.910-842-7684
1885 RUSSELL HEWETT RD
SUPPLY, NC 28462
AY
O THE
)RDER OF
BRANCH BANKING AND TRUST COMPANY
i 1-800-BANK BST BET 63q J q 1
7105
%ll %% 66-112/531
DATE el)
l G� `�
"Poo, r
�t T ":',
3000 7 LO 5li' i:0 5 3 10 L L 2 Li:000 5 2 15 79 643112

■ Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
1. Article Addressed to:
i
1 � Ofirs G©urt
1
A. Signature
❑ Agent
❑ Addressee
B. Received by (Printed Name) C. Da of elivery
D. Is delivery address different m item 1? ❑ es
If YES, enter delivery address below: ❑ No
3. Service Type
❑ Certified Mail ❑ Express Mail
❑ Registered ❑ Return Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes
2. Article Number —
(rransferfrom service 7009 0080 0001 9498 3987 -
PS Form 3811, February 2004 Domestic Return Receipt _ _ 102595-02-M-1540