Ammons, Jennifer

®i CAM.A / ❑ DREDGE & FILL F k f r':1 t No. 74982 `A BC D
GENERAL PERMIT Previous permit#
--]New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
As authorizgd 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 d /��:" r �"
�,'�r ❑ Rulees attached.
Applicant Name i• 'i 01s� U/ Project Location: County ! n�;-
Address (` / r<t ' /„ ✓ Street Address/ State Road/ Lot #(s)
City State 1/( ZIP
Phone # FUe'J-3,"c- E-Mail Subdivision
Authorized Age
Affected ' ❑ i;V , aEW' U PTA ❑ ES ElPTS
AEC(s): ❑ OEA - ❑ HHF ❑ IH ❑ UBA ❑ N/A
1-1 PWS:
ORW: /'yes /.no PNA yes /"no j
Type of Project/ Activity
Pier
(dock) length_
Fixed Platform(s)
Floating Platform(s)
Groin length
number
Bulkhead/ Riprap length
avg distance offshore
max distance offshore
Basin, channel
cubic
Boat ramp,
Boathouse/
Beach Bulldozing
Other
Shoreline Length
SAV: notsure yes ((.no
Moratorium: n/a yes
Photos: yes }Ino
Waiver Attached: yes no
f
A building permit inlay be required by:
( Note Local Planning jurisdiction)
Notes/ Special Conditions
Agent or Applicant Printed Name
Signature "` Please read compliance statement on back of permit'•
r l .� .
City . t ZIP J
Phone # () Ri er Basin !'
Adj. Wtr. Body.. ✓�✓� nat man /unkn)
J
Closest Maj. Wtr. Body5-
Signature
(Scale�/,j,J / e)
❑ See note on back regarding River Basin rules.
Feels) Check# Issuing
Date

Cannon, Amanda J
From: Jennifer Ammons<[e-mail]>
Sent: Friday, May 10, 2019 9:38 AM
To: Cannon, Amanda J
Cc: John Ammons
Subject: [External] Ammons - 221 Jones Street - Adjacent Property Statement for Pier Repair
Attachments: Ammons - 221 Jones Street - Adjacent Property Statement for Pier Repair.pdf
IMMENILmal email. Do not click links or open attachments unless you verify. Send Mu pious email as at attachment C
AW
Amanda,
Per our conversation, please see attached signed "Adjacent Riparian Property Owner Statement" from Janice G. Guthrie
(left side) and David F. Winberry (right side). Should you have any questions, please don't hesitate to ask in effort to get
our permit for repair of walkway that was destroyed by Florence in September 2018.
Permit for:
Location:
William J. Ammons Jr-^"'Oi q p ` �aC7. ~ RWO Lck-,11)
Jennifer S. Ammons\
221 Jones Street
:edar Point, NC 2
Our Mailing Address: 2103 Peach Grove Lane
Zebulon, NC 27597
Thank you for your help!
Jennifer 5. Ammons [ /
Triangle Construction Services, Inc. /(/'
2103 Peach Grove Lane t� v
Zebulon, NC 27597
Office - 919-365-4800 l l
Fax - 919-365-9155
Email: [e-mail]

I hereby certify that I own property adjacent to 6e'e',t`i' �IN7� li�Ki�✓f �k�r+K S ��f
`$ S,� (Name of Property wner)
property located at 2 2-1
(Address, Lot, BI ck, oad, etc.)
on arWwa .Sa�,� in C..V402 �onn- N.C.
(Waterbody) (City/Town and/or County)
The atiapplicant has described to me, as shown below, the development proposed at the above
gh.
a— I have no objection to this proposal.
I have objections to this proposal.
AND/OR DRAWING OF PRO
Te Qou,c- � l2eQl�cr. 24 i s4--r q Jcw-L/ t.JA 1 kuAY -!J�Rt LA345; eQ 4a'otr- l b Y
1J-uert;cA-w FloRenu—
�etxxR�pb Sell'Pall `��Al Baas c�lw�u by F���•�.
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.
I do not wish to waive the 15' setback requirement.
�(PrrtO er Inforation)
Si ature ^�4« (r N14,06*0,6WAt
Print or Typ,gg Na�r�7e
z/o7 Ye�G 6cvz k•✓
7S`g 7
r 2- L - 2.000
Number/email address
Date LL
(Adjacent Property Owner Information)
Sl 1 ��AA
e �YniSUC�L/�
Print o yp N me
r�Vd
Maili A dress
City/StaterLiP,- s.ar aL1 J- 3b7�}
Telephone umb r/emailladdress
yrAt7r i
Dale
—�—
CO.s_
(Revised Aug. 2014)
*Valid for one calendar year after signature*

AGENT AUTHORIZATION FOR CAM
Q PERMiT APPLICATION
Name of Property Owner Requesting Permit:
Mailing Address:
r p 1 Pa
Phone Number:
Email Address:
I certify that I have authorized
w r-P t "
?;H`ia�tgte
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:
-ROOD (Solt,))
s.aln,
DejS .
at my property located at t oy/ PS 7 r �e �pJ�� (jr-
in County.
1 furthermore certify. that 1 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 evaluad'ng information related to this
permit application.
Property Owner Information:
Title
�l3l Ul
Data
This certification is valid through
JUN` g',2019
DCM-Mt4p. CITY