86253A_Wilke, Jeffrey_20220218

'10"rk ❑ CAMA ❑ DREDGE & FILL � � N9 86253 A B C D
GPrevious permit
GENERAL PERMIT T
Date previous permit issued
New ❑ Modification ❑ Complete Reissue ❑ Partial Reissue
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:
15A NCAC ❑ Rules attached. 0 General Permit Rules available at the following link: www.deq.nc.gov/CAMArules
Applicant Name _
Address
City
Phone # (_ )
Email
State ZIP
Authorized Agent
Project Location (County):
Street Address/State Road/Lot #(s)
Subdivision
City
Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS Adj. Wtr. Body (nat/man/unk)
AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS Closest Maj. Wtr. Body
ORW: yes/no PNA: yes/no
Type of Project/ Activity
Shoreline Length
Access Length
Pier(dock)length
Fixed Platform(s)
(Scale:
Floating Platform(s)
Finger pier(s)
Total Platform area —_____—___ ..
Groin length/#
Bulkhead/ Riprap length
Avg distance offshore
Breakwater/Sill
Max distance/ length
Basin, channel
Cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
SAV observed: yes no
Moratorium: n/a yes no "
Site Photos: yes no
Riparian Waiver Attached: yes no
A building permit/zoning permit may be required by:
❑ TAR/PAM/NEUSE/BUFFER (circle one)
Permit Conditions
❑ See note on back regarding River Basin rules
❑ See additional notes/conditions on back
I AM AWARE OF STATUTES, CRC RULES AND CONDITIONS THAT APPLY TO THIS PROJECT AND REVIEWED COMPLIANCE STATEMENT. (Please Initial)
Agent or Applicant PRINTED Name ) Permit Officer's PRINTED Name
ti_ f Q,--
Signature "Please read compliance statement on back of permit" Signature
Y:
Application Feels) Check #/Money Order Issuing Date Expiration Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit:
Mailing Address:
l� 5�L-4v a- O I\! c 2.-79 V
Phone Number: 3 c 3 I C q&
Email Address:L►�! C L 3 (2 Q/ a G �o ►�
I certify that I have authorized G k t-V 9 t&L ,
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: � V Lk N L 4 -0
at my property located at 1 1� QA7—C LN .b 02� C
inPt,�}ik:j� County.
l furthermore certify that / 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:
n J
jl Signature
Print or ype Name
Title
Jvr-'e(:/ 2 Y
Date
This certification is valid through / /

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to '� R--e -f �--,/ Y LKl I
(Name of Pr perty Owner)
property located at L' I�- L-1 It c-
(Addf4s, Lot, Block, Road, etc.)
on , in w i� , N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
locatio .
1 have no objection to this proposal.
1 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)
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.
! do not wish to waive the 15' setback requirement.
operty Owner Infi rmation) (Adjacent Pro erty Owner Information)
w
Sig a re Si �tattcre
Print or Type Name Priat or T p Name _
Maili—` ng Address Ma A dress
L-i Z�2T�U2 ;� !y L Z7� y� 77� , '�
City/State/Zip City'11tate2ip .
Teleph ne Number/ email address Telephone Number/ email address 1
Date Date*
(Revised Aug. 2074)
'Valid for one calendar year after signature"

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reception area, or mail room at 12:53 pm on June 16,
OV Delivered, Front Desk/Reception/Mail Room
June 16, 2021 at 12:53 pm CD
MELBOURNE, FL 32901 a-
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June 16, 2021, 12:53 pm
Delivered, Front Desk/Reception/Mail Room
MELBOURNE, FL 32901
Your item was delivered to the front desk, reception area, or mail room at 12:53 pm on June 16, 2021 in
MELBOURNE, FL 32901.
June 16, 2021, 12:47 am
Departed USPS Regional Destination Facility
ORLANDO FL DISTRIBUTION CENTER
June 14, 2021, 8:42 pm
1 of 3 2/ 18/2022, 10:44 AM

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Arrived at USPS Regional Destination Facility
ORLANDO FL DISTRIBUTION CENTER
June 14, 2021
In Transit to Next Facility
June 12, 2021, 1:24 am
Departed USPS Regional Origin Facility
RALEIGH NC DISTRIBUTION CENTER
June 11, 2021, 6:39 pm
Arrived at USPS Regional Origin Facility
RALEIGH NC DISTRIBUTION CENTER
June 11, 2021, 4:30 pm
Departed Post Office
HERTFORD, NC 27944
June 11, 2021, 11:23 am
USPS in possession of item
HERTFORD, NC 27944
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2 of 3 2/18/2022, 10:44 AM

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