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77846D - Blanks
1CAMA/ ❑DREDGE & FILL No 77846 A B ;ENERAL PERMIT Previous permit# —m35 New -]Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued 5 •ized by the State of North Carolina,Department of Environmental Quality :oastal Resources Commission in an area of environmental concern pursuant to I5A NCAC 37-‘'k, t2.OU (� ❑Rules attached. t Name Atl,„„ N,....,.k Project Location: County Uf�/' kc k..2 /52 rUK CI‘.rec (-)r_ Street Address/State Road/Lot#(s) 2 -55 cilcal S.)Qi..Av State N C. ZIP 2 S`1 tp2. (.) —SLI9 --1�10 E-Mail itr/.y6lh^ I�y�o5�w,1,c$ubdivision edAgent Lilt, e, c� c�Son City S-.)e,i3 ZIP 2 V � W J ❑EW (�TA ❑ES ❑PTS Phone# ( ) River Basin w^ (�'a-' ❑OEA ❑HHF ❑IH ❑UBA ❑N/A Adj.Wtr. Body 4- ,V W Ciii311 ❑PWS: A \ki ki Closest Maj.Wtr. Body yes / PNA yes / - // Project/Activity n��.\� �t.-� �a-���t� G x ;.� ` e?ct`,� Cb C (Scale: N I :k)length dorm(s) 1l 1(y L, 1 �'i11. tpL` I I Platform(s) N4 �� , , ! �t `yl� I_ I ler(s). Lf NIT !--�++-+. ��"� y�+ 1 \a, e°'-\...........- T rigth * 1 11 i Tiber , i/Ri P P length h ....I— _ 4 . - 1� gt - v1v ;distance offshore i i x distance offshore j i cannel { f L,}wS 1' I rotr )ic yards 1 ,p R 1 j t se/ 1 k 3 - ..- �— -- — i — 1 --- JIldozing I7 i y rs0 � -- ��bo,,� --- IV. a Length '� �1 f:. �� i not sure yes no J! �� j _..j..__....__._ %vv, ium: n/a yes 1 attached: es no 2 ! 121 , �C F'ut. I 1 2%Jr s"c,^"--5 permit may be r�ired b : (,,,.\ ,,\( Co,,j,"-k-X.„_ ❑See note on back re ardin River Basin r & Y 9 Yregarding Local Planning Jurisdiction) AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION • Name of Property Owner Requesting Permit: Jerry Blanks Mailing Address: 2829 Pirate Shores Drive Supply NC 28462 Phone Number; 804-349-7840 Email Address: jerryblanks1947@gmail_com I certify that 1 have authorized Will Richardson Agent 1 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 boat lift and dock extension at my property located at 2255 Shane St Supply NC 28462 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: r),e, .0€6714._ Signature J ere,/ M . 2/a,✓,tr Print or Type Name Title - - owen - " ' ss Bu$a �PPb� ! �'1 8 a°8 o AS �¢ 3�Ys' �1j 6Z98 " ewef 4/10 4uPd N 19%L-11 'W O U H sN 'Cu 41./ admvuas id nzaiS syrr o `If*/ .14t TY11 -armerip, .1/1 {uol;euuowul Jeumo void Ittaaefpt1) (uogewuoJui laumo Aaado ) juawaatnbaj Noeq;as,ql, alp aAlenn o; gswt;ou op I an] luewa ribai )P aii *qsu o i I. aiaq (`hnofaq Nuelq a}eudoidde aq lel ua;srnu noA ` eglas alp ysirot noA II) -aw dq panM2M ssalun ssaooe ueuedu Jo Bale Itw woq ,r6 �o aoueisip tunutiwW 3s aq Isms utoab ao ` `asnotmoq 'ialenruleaiq `s6utlid 6uuoow `mop said a pue}siapun N011.O3S N3AIVM r 'SNJ/ ? U N3a. i woq Jo }uamua3Eidall reap eye e tpepe dO Nu uoidttosap ur fig 7sn€i;ueutdo eAap Bulsodasd,enphvpuf) 1N3Fid013A3Q Q3SOdO Jd 3©9NIMVIQ doIQNY N©LLdDIOS3Q ?esodo+d sit!'o;suotlaargo aney t ` doids--o O; ou aikeq ) : alau Tel e q} e �e��e pasodotd luatudolanap ag; `naolaq annoys se aw of paglsosap seq lueorldde at#Z (Alum*wlpue umta,tjAmo) f Ap e }N ATddns ui ` MM1V uo (-aka'peogl '43ale col 'ssaappy) T,iaumo oid a a�N) auetTS SSZZ fai ALadoid sal uelq kua f 04 1ua-Jefpe Apacioid Uivto I leg/Sao Ageieq I • 1N3IW3IYt.IS IONM°AL 3dO2Id fVitifdl2t 1N3OVi'Q ' ADJACENT RIPARIAN PROPERTY OWNER STATEMENT i hereby certify that I own property adjacent to Jerry blanks property located at 2255 Shane St ( me of Property Owner) ors AIWW (Address, Lot, ick, Road, etc.) , inSupply , (Ws atei body3 (City/Town and/or County) The applicant has described to me, as shown below, the development proposed at the above I itial here .:V I have no to cs iiilss jBci, s � ai; I have objections to this propel. DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT (individual proposing development must fill in description below or attach a site drat Replacement of boat lift 1)oc ex4eNSia-hi WAIVER SECTION I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be se minimum distance of 15' from my area of riparian access unless waived by me. (If you wish the setback,you must initial the appropriate blank below.) l here � � s etback. Jr wai to ;e_1 s nt.: -fere I do not wish to waive the 15' setback requirement. (Property Owner Information) (Adjacent Property Owner_lpforrnation) 81 301/ Signature 'S — a fir,ure (� 7 rr1 (7, 13/Q,✓KJ' S epAP,v /i7rs Print or i Name Print or Type Name Shores Or. SW a839 P;,q s.A r Or Ski Meiling Address Mailing Address ADJACENT RIPARIAN PROPERTY OWNER STATEMENT • I hereby certify that I own property adjacent to ,.y 2.6 A/j< - 'Name of Property Owner) property located at 2 2 5-5- S4awr Si` (Address, Lot Block, Roads etc,) on A� w kV . in Sc� �/yy , hl_C (Waterbody) (CityiTown and/or County) The applicant has described to me, as shown below, the development proposed at the above lc X l have no objection to this proposal. have objections to this proposal. DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT (Individual proposing development must fill in description below or attach a site draw ?ep lace i-r PAril cr Z3 ci a 7< X ;,c7( �c`1 C Jc f�X .LPN S 10A) WAIVER SECTION I understand that a pier, dock; mooring pilings, breakwater. boathouse, lift, or groin must be se minimum distance of 15' from my area of riparian access unless waived by me. (if you wish I the setback, you must initial the appropriate blank below.) X 1 do wish to waive the 15' setback requirement. i do not wish to waive the 15' setback requirement. (Property Owner information) (Adjacent Property Owner Information) C4_4-7 1?-1 1:3.6"%e 441 Szgnarure Signarure /cw, r J PPtPr Gratale Print or Type Name Print or Type Name 2!29 %�%t"� JAr r r S. '72i! d 1213 Culbe�rth Dr jE}+d ��F s J.u�Sl Q uP . . . ,. . moomy oa.m.ya .2w 6Sktit 61 surrox tic.264i4 -14rt -so t SCOPE OF INORK: r i t Replacement of boat lift 44 addition to access lift bx16 addition for seating I ic1-;4.:.:.::::':...:..-..-.:;,.......,:—.....,:.%-.....;..... ,,, .....„.,..„---0 ! I ' 1 ; titie''IA A 1 / I 'El 60F1 614tAti.161 0046611, Itleti rit.ANt4 41 1 26 t`r. ...re.0 . J ,ONAIIC 61 r i $VPOLY MK,21146;,:.' t i rA,0663Wgem,,N7,--,,, r.,,,ztiovortr-11.31:.ti,•.-t-pir....01..A0,,,ormory4,?..-26P...-traretrttitisstm,60.11.0,...P'..-n"'lv. . - 04444164 . US I i efisiiA5 r rilt11..A1406 1 1 1 ,i Qte pOStS i 1 64 4 $4110 i t1061/4.6tei0 40 60 ot r A,... :• '-'•?-teir-•-, -4..„.,._ • ----ve-i W‘l-tS. c(*.ok-kOriv• I ,q. i ..o. o 0 4: TS 4 M 00 L:,,,,,,,,,,,..,....,.....,h'-,;4..',4.,%..;;+,4,4,,,:i.lsaiqraipaywhip. 14{itAikir;;,i1/44WhrtditatiAti,i00.100043,4410.4040,11.44.44404/44P43404,r,i)L40.44,461 ,4kAdAdow,thivkijava4,0,61044,t, 1 •••i i lin MOM 1 Pleftld CAD ati 1 i ft:VAT Tr 1 1 I 1 • i i 1 41 >.. .., ......, —. •—s a, .... ............ .4.. µ ..... .1004"W”4.e T1 0 4 ,p03,16,tAtif fi neca Date Received Date Deposited Chock Flomamount Name of Permit Folder Vendor Cheek Number Permit Number/Comments Columnl Column2 Column3 Columba , Column5 Column Column7 Column8 10/1/2020 AMW Docks and Marine Construe Allan Campbell BB&T 5981 ###### GP#77863D 10/1/2020 Aaron Perkins Duke Energy Progress LG FCU 393 ###IPThit GP#77621D 10/1/2020 B and B Coastal Construction Cor Hanifa Haji Wells Fargo 1198 ###### GP#77860D 10/1/2020 Cohen Construction,Inc. Robbie Cohan Uwharrie Bank 20541 ###### GP#77865D 10/1/2020 Willie Clarence Richardson/RichaiJery Blanks BB&T 7788 GP#77846D 10/1/2020 Erosion Control Specialists,Inc. Robert E Bell Jr. BB&T 1002 # GP#76482D 10/1/2020 Stature Engineering,PLLC Norm Brown/Safe Harbor Branch Banking and Trust 155 ###### GP#78805D 10/1/2020 Bruce Knott same Bank of America 1395 ######I GP#77806D