Missner, Tim 76681C

/trDREDGE&FILL N9 76681NER/AL PERMIT ABCD
Previous permit #
fJNew EModification [lComplete Reissue EPartial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality
andtheCoastalResourcesCommissioninanareaofenvironmentalconcernpursuanttol5ANCAC.
Applicant Name ._
Address Street Address/ State Road/ Lot #(s) .
State ZIP_
Phone # (_)Subdivision
City zlP
Project Location: CounV
. ,ClV IEW I PTAAffected
AEC(s): oEA - HHF lH
I PWS:
ORW: yes / no PNA yes / no
!ES
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Phone # (_)River Basin
Adj. Wtr (nat /man /unkn)
Closest Mal. Wtr. Body
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Type of ProjecU Activity
(Scale:)
Pier (dock) length
Fixed Platform(s)
Floating Platform(s)
Finger pier(s)_
Groin lengh
number
Bulkhead/ Riprap length_
avg distance offshore_
max distance offshore_
Basin, channel
cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
Shoreline Length
-
SAV: not sure
Moratorium: nla
Photos:
Waiver Attached:
yes no
yes no
yes no
yes no
A building permit may be required by:
( Note Local Planning Jurisdiction)
I S"" note on back regarding River Basin rules.
Notes/ Special Conditions
Agent or Applicant Printed Name
Signature ** Please read compliance statement on back of permit **
PermitOfficer's Printed Name
Signature
Application Fee(s)Check #lssuing Date Expiration Date
E.Mail
-
Authorized Agent ' ''
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Stetement 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
nullandvoid.
This permitmust be on the proiect site and accessibletothe permit oflicer when the project is inspected forcompliance. The
applicant certilies bysigningthis permitthat l) priorto undertaking any activities authorized bythis permit, the applicantwill
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 satement 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 avaihble
information and belief, certirythatthis project is consistentwith the North Carolina Coastal Management Program.
River Basin RulesApplicable To Your Proiect:
Tar - Pamlico River Basin Buffer Rules
Neuse River Basin Buffer Rules
lf indicated on front of permit, your proiect is subject to the Environmental Management Commission's Buller 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 (252-945-6481) or the
Wilmington RegionalOffice (910-796-7215) for more information on howto complywith these buffer rules.
Division of Coastal Management Oflices
Morehead City Headquarters
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/ | -888-4RCOAST
Fax: [phone]
(Serves: Caneret, Craven, Onslow -
Nonh of New River lnlet- and Pamlico
Counties)
Elizabeth City District
401 S. Griffin St.
Ste. 300
Elizabeth City, NC 27909
252-264-190t
Fax:-252-264-3723
(Serves: C.mden, Chowan, Currituck,
Dare, Gater, Pasquotank and Perquimans
Counti6)
E othe.'
Washington Di3trict
943 Washington Square Mall
Washingon, NC 27889
252-946-6481
Fax:252-948-M78
(Serves: Beaufort, Benie, Hertford, Hyde,
Tyrell and Washington Counties)
r/Yilmington District
127 Cardinal Drive Ext.
Wilmington, NC 28405-3845
910-796-7215
Fax: 9 I 0-395-3964
(Serves: Brunswick, New Hanover,
Onslow - South of New River lnlet-
and Pender Counties)
hnp://ponal.ncdenr.org/web/cm/dcm-home
Revised 7/06/ I 7
AGEI*I AUTHOSIUATION HOR CAI{I& PERllltlT *PPLICATIoN
Narne of Property Owner Requesting Permit fi..ro r'a i Sene"f
Mailing Address:3482 W 109th Circle..
Westminster, CO 80031
Phone Number;
EmailAddress:
I certify that I have authorized
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to act on my behald for the purpsse of applyins fcr and oblaining all CAMA perrnits
necessarlrforthefollorafing proposed development: r''on$tf.r4Qti Qn gr*...a . ,
nf W V ir\I \ h\'iFh.f,.fi;d...,ey\d r.qn&f etp., d,nr K . .,.,,.,.**
-at my properly lssated at
in oar+r,fct-County.
Froper{y,Orrner lnfcrmation:
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Pint ar TypqiVarne
This ce{ifica-tisn is velid lhraugh - ./ /_ --_
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an the fliis
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0e/0P t2020 r
Date
I hereby certify that I ou,rn property adjacent to $
propefcy located at 1 o*Qun
r
(Name ofProperty Owner)dr'r VE
on
(Addrcss, Lot,Bloch
(IYaterbody)N,C.
County)
hffin*nt has described to me, as shown beloar, fie development proposed at the above
I have no objecton tothis proposal.
I have objecfions to this proposal.
DESCRIPTION
in
DRAYT'ING OF
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Owner
asftedhar*fng|
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% I do wish to waive the 151 sEl6sr i Fquirelnent
% I do not wish to waive the 1s sefrack requirement.
{Property {Adjacent
Signaare Signatue*
Pint or Twa Name
Date
*Valid fior one calendal yearafier elgftature"{Revised Aug- ZOt4}
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or groin
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unived by
.t krehycertiUthat loun properu adiecertto T nn Ml SsnoF
property located at 1Z 9* so ddr rVO
(Name ofPrcperty Owner)
on {Address, Lot Bloclq
in
ts
N.C.
(CJtyIIown County)
IHr?Jn*nt has described to mg as shovvn belour, the development proposed at the above
-
I have no obJection tothis proposal
-
I have objections to thls proposal.
findffiduat drawlng)o6
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% I do wish to waivethe lsselbas{r.rquiremurt
% I do not wish to waive the ls se&ack requirernent.
(Prope*y Owner Infonrafion)(Adjacent
Stgnatre
Telephone
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Print or Twe Name
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Data
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11t1912024 USPS.com@- USPS Tracking@ Results
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Tiacking Number: 7 4244640000027201 836 Flemove X
Your item was delivered to an individual at the address at 1:54 pm on October 9, 2020 in EMERALD
ISLE, NC 28594.
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NC Division of Coastal Management
Cashier's Official Receipt
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<.
72502 A B@ D
tt/es aoDate:20
Received From:
Permit No.:
$Q00
L Check No.:lbz q
County:{-Applicant's Name:T l.i << tto
Project Address:72aq 5 tt n) t\n
Please retain receipt lor your records as proof of payment for permit issued.
Signature of Agent or Applicant: --l--_-
Signature of Field Representative;
Date:
Date:
)a
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