80199D - Blankenship

gl CAM / 0 DREDGE & FILL
No 80199 C
GENERAL PERMIT Previous permit Of A
KNew Modification !Complete Reissue Partial Reissue . B
Date previous permit issued ___
As authorised by the State of North Carolina.Department of Environmental Quality
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC 071.100
: Rules attached.
Applicant Name Lott vkista.1441ASIAL .------- --
. S Protect Location: County ennsiusci_ -
Address__65±_imquiiL Ile&
— Street Address!State Road/Lot#(0.10P_Ven211_
City_1411240049± state i1/4C_ziPliVi, , 3910 lA/est 4/,,Arn --
Phone#(14 ) 6.31_5(16_1_Email ._e_tf:.1101cuttill4;ieLvetryiN Subdivision
Authorized Agent CP4 Lit, city &i. 6 -ild ZIP,gg'465
Affected E.-Cw REV( Id PTA IDES OPTS Phone# ( ) River Basin
1.2 0EA J HHF 77..]IN 0 UBA `..7 N/A man /unite)
AEC(s): M.Wtr.Body /
om, y. ,& PNA yes
Closest Mat.Wtr.Body ez ,w_____ ____
/0
Type of Project/Activity i'airx-si/4 e#7xiimefitY041.edieii# it/.?-5145
(Scale:
,/ .....y/
Fehr(dock)length ti#A.„.,
.,, jt ,.,„ eftiXibki-l-cit..„, ...-----
Fixed Platform(%) .... _ ,,y,..-I' i . , %,".... , ' 0" _1 ' - —
Floating Platform(%) IC se 12 1 .Y 1 ' , , .7 ' i " ' 7"7- i 1 t r ,
,
4,/
'-
Finger '''' , '..4 i --ti-litillilli -4-
Groin length _ — 1
r ilrip:
number -- i
n
I. 1
Bulkhead/R4prap length 4-4. '"-- IMMO I
4ItJavg dutance offshore— ' -v-
max distance offshore "'"' 1 I
. 1 , , ,..
Basin,channel .-.. 1 , . ' -I-4- t I- f
..-- } i r __. ..„"ir. )/• I
cubic yards "'"'"-- i i I ±/7"---L--Ni Pik C. / ,
, , ,
Boat ramp c---- ll 1 :, Ler/Slag 0..".
Boathouslar tik.4S" pi ---` - -- j,,,
-1 . 4a44/f ot'a .
WS 4
. .,
..,...—
, 1 1 4-1 1 1 4
Beach Bulldozing . i
t
I i
_. .....,
t
- t I
t
Shoreline Lthyr-c.-.. - , , g ÷.
If- , .4
I
: _ ____,.._
,
eng
sAv• not sure yes S - i i ! , LI -.-t- -ta
Moratorium. nia yes 19 _ .....t: ,... ....
Photos. ; a .. _ ,
1 tAn't ft , .
--"?.
Yes 09
II W z
atver WA 0 no --- '
Witau
A building permit may be required by: syler
gi- ,Witeke- E See note on back regarding Paver Basin rules.
71, (5/.---
(Note Local Planning JurisdictiorZ
Notes/Special Conditions 444 4
5' 474/-DIX) liakthfAr144it22-"fil
6 ef\ 6 r.t.\ CPC, LL C ,
g2s--2.1
Perm Officer's...Printed Name
Agent or Applicant Pri ed Name
f3--(/`• ari-iPtIN I 2-25-21
Signature ,...Please read compliance statement on back of permit" Signature
A00411 /045 _e/2,5231 Application Fee(s) f2A5t _
Check* Issuing Date Expiration Date

41❑CAMA/ ❑DREDGE & FILL No 80199 A B C
GENERAL PERMIT Previous permit#
YZ ❑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 I 5A NCAC . .
❑Rules attached.
Applicant Name (Ati G �vist� l5 l e,ove�S�i Project Location: County '',-;f;cif,(-�C
Address 651 Street Address State Road Lot#(s) D
City Fupat tiO /iil(;' State (•C ZIP 27',16' q/i L41 SY •o;!-'1,,,,
Phone#(,!i y ) /3? 506 9 E-mail cif' fit,c-lkkP4614{?cftp,((yi. Subdivision —[[
Authorized Agent (P6 LLC, City Uc'k /5t"!‘ ZIP (if465
Affected ❑CW ®EW ®PTA ❑ES ❑PTS Phone# ( ) River Basin Z,.//4?"
AEC(s): O� 0 HHF 0 IH ❑UBA ❑WA Adj.Wtr. Body / 417' 7�t-19// Lna,t /man funk
❑ PWS: •
ORW: yes / no PNA yes /no Closest Maj.Wtr. Body '7( G(L("
Type of Project/Activity 't4ni f/1/1(7 4157d4 !
/
(Scale: rZ7rS )
Pier(dock)length `,
M v "
Fixed Platform(s) 7
Floating Platform(s) ! "; ...g1
Finger pier(s) — , ij/
�/
a
•
Groin length I Y
number — _ i ..............................— T_...._ __��— j
Bulkhead/Riprap length _. —_ � �......_.._._._..._.._.. /,Kd-�._ ��_...__� � __
. �� i
avg distance offshore — i ' �ow� 7
max distance offshore ' _
Basin,channel - a t
I i I r I
cubic yards --- I ,�.1. / i
Boat ramp i
Boathouse/Boatlift :_ .._.._.. ' CCA - � !
-1 I
s
Beach Bulldozing /V ' i ,
I I I j
Other K ^'fP �y I,
" 70I • Yl'
Shoreline Length 14
I
SAV: not sure yes e {
,gip
Moratorium: n/a yes ' ._ _111
_ _ -. .... . __��.rittitai
Photos: yes
Waiver Attached:` yes; no Le. 3105
A building permit may be required by:Ti,wr/ ep'02C e. . ❑See note on back regarding River Basin rules.
(Note Local Planning Jurisdiction) v J
Notes/Special Conditions ' /1C ttbicT, P /ii4, ,1,.fi-l7f �l4' /`'
4-6-dAtd .
Agent or App nt a 'anted ame Perm Officer's Printed Name
r/2r/ lisitro
Signature **Please read compliance statement on back of permit** Signature

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: Scott and Krista Blankenship
6513 Prestwick Place
Mailing Address:
Fuquay Varina,NC 27526
919-637-5069
Phone Number:
scoff.bl a nke n ship©m e.com
Email Address:
CPG, LLC
I certify that I have authorized
Agent/Contractor
to act on my behalf,for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: new docking facility
Parcel ID 234PA011 (3910 W. Dolphin)
at my property located at
in Brunswick County.
I furthermore certify that I am authorized to grant, and do in fact grant permission to
Division of Coastal Management staff, the Local Permit Officer and their agents to enter
on the aforementioned lands in connection with evaluating information related to this
permit application.
Property Owner Information:
Soa riel/s it,
Scott Blankenship(Apr 14,20211:29 EDT:
Signature
Scott Blankenship
Print or Type Name
Property Owner
Title
4 I 14 2021
Date
4 14 2022
This certification is valid through I 1

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to Scott Blankenship .s
39.0 W.Dolphin L5 B-J o;i (Name of Property Owner)
property located at Parcel ID 234PAoi i
IN men s[ (Address.Lot,Block,Road.etc.)
on sue° `Jtirh ,in Oak Island I Brunswick .N.C.
(Waterbody) (CitylTown 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.
Ns,,,Me,.'d,AD,S.ZIRJ 9JA PJf1
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must MI in description below or attach a site drawing)
Proposed docking facility with covered
gazebo, floating dock, and boat lift.
WAIVER SECTION
I understand that a pier.dock, mooring pilings,boat ramp,breakwater,boathouse,lilt,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.)
"� �^*•M,pJi OJ W�GEP I do wish to waive the 15'setback requirement. "Allowing up to 3'into setback"'
I do not wish to waive the 15'setback requirement.
(Property Owner Information) (Adjacent Property Owner Information)
,2Ctt -7
r•.,I+4:..x.-,J,,, r,: 1.1 11 Nwr,BWCWAo.:S.S'11WAEJTI
Signature Scott Signature' Kerry Blanchard
Print or Type Name t3 Prestwick Place Print or Type Name 4 Possum Lane
Mailing Addressy Varina.NC 27526 Mailing Address new Milford.CT 66776
City/Stale2ip acott.bhnkensliipftime.com City/State/ZIP keny.blanchardra*merck.cum
Telephone Number/email address Telephone Number/email address
Dal 4/14/2021 Date' 4/15/21
(Revised Aug.2014)
'Valid for one calendar year after signature'

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certrfy that I own property adjacent to 's
(Name of Property Owner)
property located at Sato W' Dolphin l 5 R toSR Parcel II)23.0P
on montr.�„�..4' fi (Addresrs. Lot. Block.Road.etc.)oak D N C
(Waterbody) (City/Town and/or County)
The applicant has descnbed to me as shown below the development proposed at the above
location
sr-J1', I have no objection to 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 drawrngl
See attached drawing of new docking
facility.
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 )
I do wish to waive the 15'setback requirement
1't I do not wish to waive the 15'setback requirement
(Property Owner Information) (Adjacent Property Owner Information)
.^ tee. .71144-__---
Stgnarure Signature' Florence or r..larence
� f.tt Rlanken.htp
Pont or Type Name 65I I prestwuk pia.e Print or Type Name 3a,8 w Iklph,
Malting Address I uqua. \'artna.tit-2706 Mailing Add•ess Oak Island.NC:±xse;
City/State/Zip scott.hlan►enshipwme.com C+ty/State2tp 28465
Telephone Number/email address Telephone Number/email address
Dare 4114/2021 Dare• 04/29/2021
(Revised Aug 2014)
'Valid for one calendar year after signature'

3910 W. Dolphin
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3910 W. Dolphin 1
Proposed Docking Fac ilay
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*Note:Approximate measurements based on aerial imagery(GoogleEarth).

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Cheek
Date Received Date Depoalbd Cheek From(Name) Nam of Penult Holler Vendor Cheek number amount Permit Number/Comments Receipt or Refund/Reallocated
Cofumnt Column2 Cokmnn9 Column,/ Coumn$ CalawN Colu n7 Column8 Column
92/2021 9/7/2021 Judith Kuser same State Employees CU 4489 $ 400.00 GP 880193D PA rct.12797
9/2/2021 9/72021 Scott Blankenship same Bank of Americo 1045 $ 200.00 GP 080199D --_--- PA rct.12800
9/2/2021' _ 9/1/2021 Southern NC Marine LLC Charles Todd Parka First Bonk 1470 $ 200.00 OP 9802540 JD rct 14924
922021 9/1/2021 Southern NC Marine LLC Stuart Sanderson First Sank _ 1471 $ 200.00 GP 980253D JD rct.14923
8/72021 9/1/2021 Maritime Coastal Construction,LLC Bill Thomas CresCom Bank 3408 $ 600.00 GP 9803030 BB rot 15619
922021 9/1/2021 H5 Construction.LLC Kimberly Swain Truist 1072 $ 200.00 GP 980284D BB rct.15526
922021 9/1/2021 HS Construction LLC Kelly and Sharon Jarvis Truist 1076 S 200 00 GP 980285D BB act.15527