Blonk, Andrew 80689C

CAMA / REDGE & FILL 9 80689 A B
ENE L PERMIT Previous p ermit #
New ❑Modification [---]Complete Reissue El Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality, I
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
&,�;Frules att ed.
Applicant Name Project Location: County
Address 4, Street Address/ State Road/ Lot #(s)
Cit 1
11 _j.VStateZIP J `
Phone # ) t+c "' E-Mail Subdivision
Authorized Agent
❑ CW
)4EW
)(PTA ❑ ES ❑ FITS
Affected
AEC(s): ElOEA
❑ HHF
❑ IH ElUBA ❑ N/A
❑ PWS:
ORW: yes / 0
PNA
yes
Type of Project/ Activity
Pier (dock) length_
Fixed Platform(s)
Floating Platform(s)—'�
Finger pier(s)
Groin length
number --
Bulkhead/ Riprap length--
avg distance offshore
max distance offshore
asin hannel f t}
y
cubic yards
Boat ramp
Boathouse/ Boatlift---------------
Beach Bulldozing
Other —^
Shoreline Length edeU�—
SAV: not sure yes n
Moratorium: n/a yes no
Photos: yes no
Waiver Attached: yes o
A building permit may be required by:
( Note Local Planning Jurisdiction)
N,Qtes/ Special Conditions
or Applicant Printed Name
Signatur " Aase read compliance statement on back of ermit **
Application Fee(s) Check #
CityqFdT'-Iwal&A
ZIP_
Phone #ver Basin
Adj. Wtr. Body
Closest Maj. Wtr.
Permit
(Scale:
❑ See note on back regarding River Basin rules.
90 .n" I-p-: D 1f;i)'V, LI,)J.f/r
30/
Date

Statement of Compliance and Consistency
This permit is subject to compliance with this application, site drawing and attached general and specific conditions. Any
violation of these terms may subject the permittee to a fine or criminal or civil action; and may cause the permit to become
null and void.
This permit must be on the project site and accessible to the permit officer when the project is inspected for compliance. The
applicant certifies by signing this permit that I) prior to undertaking any activities authorized by this permit, the applicant will
confer with appropriate local authorities to confirm that this project is consistent with the local land use plan and all local
ordinances, and 2) a written statement or certified mail return receipt has been obtained from the adjacent riparian
landowner(s) .
The State of North Carolina and the Division of Coastal Management, in issuing this permit under the best available
information and belief, certify that this project is consistent with the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
❑ Tar - Pamlico River Basin Buffer Rules ❑ Other:
❑ Neuse River Basin Buffer Rules
If indicated on front of permit, your project is subject to the Environmental Management Commission's Buffer Rules for the
River Basin checked above due to its location within that River Basin. These buffer rules are enforced by the NC Division of
Water Resources. Contact the Division of Water Resources at the Washington Regional Office (252-946-6481) or the
Wilmington Regional Office (910-796-7215) for more information on howto comply with these buffer rules.
Division of Coastal Management Offices
Morehead City Headquarters
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/ I-888-4RCOAST
Fax: [phone]
(Serves: Carteret, Craven, Onslow -
North of New River Inlet- and Pamlico
Counties)
Elizabeth City District
401 S. Griffin St.
Ste. 300
Elizabeth City, NC 27909
252-264-3901
Fax: [phone]
(Serves: Camden, Chowan, Currituck,
Dare, Gates, Pasquotank and Perquimans
Counties)
Washington District
943 Washington Square Mall
Washington, NC 27889
252-946-6481
Fax: [phone]
(Serves: Beaufort, Bertie, Hertford, Hyde,
Tyrrell and Washington Counties)
Wilmington District
127 Cardinal Drive Ext.
Wilmington, NC 28405-3845
910-796-7215
Fax:[phone]
(Serves: Brunswick, New Hanover,
Onslow - South of New River Inlet -
and Pender Counties)
http://portal.ncdenr.org/web/cm/dcm-home
Revised 7/06/ 17

qod
4 153(19
AUJAI:tN 1 KINAKIAN F'KU)'tK I Y UVVNtK J I A 1_ tMCN I
I hereby certify that I own property adjacent to A, -AT Cw QloN k} 's
(Name of Property Owner)
property located at �6 ��• <<� « � -
_�%4,.1 (Address,Lot, Block, � �.) -�-
N.C.
on v,f1k- inc,.-
aterbody) (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.
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)
-T,—r ri, c_- t.f-,kv/
L
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 16 setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information) 4((Adl,e t Prope er Information)
Z
Sig lure Uj±�R-
re'
Print or Type Name Print or Type a
l y� �1 _ 3 Cc a l la ce
Mailing Address Ma ddress
City/5tate/Zip city/State/Zi
C21^ �;eo ao7-i
Telep"? a umber/email address �-Telephone Number/email address
—�ECEIV�D-oa?C l
,Date
r _ AUG 1 9.2021 (Revised Aug. 20 l4)
DCM-MHD CITY

UJAUhN 1 KINAKIAN VKVI'tK IT VWNkK , I A I tMkN I
I hereby certify that I own property adjacent to dw, w Oo- k-i 's
(Name of Property Owner)
property located at �� ll ^ ��-
(Address, Lot, Block, Road, etc.) �,
on �lIc �'✓�cf� In Cart�� C�"— N.C.
tWaterbody) (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.
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)
1.1.,4v,- & �L f-- L,,.rL'-4c- to W` 140`
r
alit
lr.ok-
WWI,VER 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.)
1 do wish to waive the 16 setback requirement.
I do not wish to waive the 15' setback requirement.
(property Owner Information) (Adjacent Property Owner Information)
4
Si lure Signature'
ex M IL,I. A 01:P G . we-s -i 4 ;rk.
Print or type Nan Print or Typo Name
Mall/ Address Mailing Address
A City/5tatemp
ry?�� �2i- 2200
Telep umber/email address Telephone N mbar/small address
_G I ,► �G�S" 2n1/
Die
RF
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AUGA 9 mi
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(Revised Aug. 2014)

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