86249A_Ammons, Michael Keith_20220215

',,,Z,%JCAMA k DREDGE & FILL ` No 86249 8 C ` p
G IE F- E RAL P E R RA I T Previous pernut
Due previous permit Issued
(� New ❑ Modification ❑ Com let o-:
p e slue ❑Partial Reissue
As aLdWUW by the Scme of North Carolina. Depumn, d invtronmand
I SA NCAC / (z ' 1106 Quaiky and the Coast! R-ouraes Cortvninionn in an area of erntorxnancai concern pursuant to:
❑ Rules ansached. ® Gmwal Permit Risks avaiktbie at the fopowtng link WapeLQMncaov/ �..
Applicant Name nn Kati e'+ d nZ f n
Address Z � I 0, oo v. f kp P !� AtKhor,zrd Agent+1►f. �r / OCen >t S; `e,�i?-btc a rs
-------=•,�• Seca ZIP Pro)ect Location (County): � ,l..iite:.,.)Qt�
--�� — 0. 1 { Street Adthosr,'S. Raad/Lot /(s> Gs 7 -d Sg
Phonec3L>_'{�2 "'-JIbZ _ �n1_Cl,en Aunt D
Errrall i't itt ry1�.` a r y.P m ` 1 k?kox e
r Subdlrizion
City— C�dex� rr zip 21932 _
Affected ❑ CW ❑ EW PTA ES ®PTS AEI. Wtr. Bodr )�RI Ina�rnart/unic)
AEC(s): ❑ oEA n INA ❑ Lfw SRMA MWS
oltw: yes/10 PNA, o C>aseu rw. won boor — i iaEmc� r iQ •3ak r,at
T1►Re of Project/ Activity
210'
Shoreline Length t 2 G6 ($Gale: f ~
Access Length i _i . }. _ i i i i _i ) i r ( ' r—e—r'T^ Ti i i - ', • "r". . ,
Pier (dock) length
Fbted Platforrn(s)
Floating Platform(s)
Finger piers)
Total Platferrn area
Groin feneth/S
ulkhea Riprap lerVh
Avg distance offshore
Breakwater/Sill
Max disunce/ length Z
Basin, channel
Cubic yards
Boat ramp ^
Boathause/ Boatitft
i
Beach Bulldozing
Other ^
i
SAV observed: `
Y13
Moratorium: t� yes no
Site Photos: 3; no
Riparian Waiver Attached: yes no
A b-ifle'ing permf/renk+= min may M mquired b%r: rs_+v
Permit Conditions
1 AM AWARE OF STATUTES, CRC RULES AND CONDITIONS THAT APPLY TO THIS PRO)
I-T. R . M/' // q q ") --
Agent o plicant PRINTED NIme
Slgna a —Please read mmpfia statement on bads of penult••
Jgoo I 4-,'' 118r17
Application Fee(s) Check M/Money Order
Permit Oificer�, PRytTF1,Name
.4
© TARJPAMlNEUSE/BUFFER (dude oru)
See note on back regarding River Basin rules
See additional notes/conditions on back
(Please
Slgnalure s•.
Z1rs1Zz �lr�rzz
Issuing Date Expiration Date

Name of Property Owner Requesting Permit: A rYN Y11o/i,5
Mailing Address: _j0I aAe-e,,N Ay*vte� - Emi-dn W- 2- cI3Z
Phone Number: 2514224162
Email Address:i i�t amMo fauJ� bi'iYtAr� n� cam
I certify that I have authorizedIyt; limn )n[Pnn Gon �rac5
Agont / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: ZtC) L-F 0-- Lf - 5 a h
v in v l b�, (ti.t�ettd
at my property located at _ -30 1 QL)ec(1 Anne DC ✓e E'3eA-bn QC -
in _C�lth._Yin County.
i furthermore certify that l 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:
1'4?1?1 f%lfwzxf
Signature
Keith Ammons
Print or Type Name
Tdle
Dec 29,/2021 / Mr
Date
This certification is valid through I t

N.C. DMSION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
CERTIFIED MAID, • RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property Owner. ire ,'A+h A-t wyio L's
Address of Property: 30
Mailing Address of Owner ,1D1
I�e,�,;a vtiwncir5 � ,
Owner's emalk Owner's Phoned aSaZ- 4a�- `f I loZ
Agent's Name: ,e Pal ;1 Lr OCectn2d C Agent Phone#:
Agent's Email: OCeoin ,,'d i ()n�
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adjacent Property Owner
I hereby oottify that I own property edjaoentto the above roferoncod property. The individual applying forthie
permit has described to me, as shown on the attached drawing, the development they are proposing. 6
100 NOT have objections to this proposal. I DO have objections to this proposal.
If you have objections to what Is being proposed, you must notify the N.C. Division of Coastal
Management (DCM) In writing wfthin 10 de)c of r000lpt of this notlea. Corrospondonoo should be
malied to 401 S. Grffffn St., Ste. 300, Elizabeth City, NC, 27909. DCM representatives can also be
contacted at [phone]. No n*sponse Is considered the same as no objection if you have boon
notified by Cerdfied AMY.
WAIVER SECTION
I understand that any proposed 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
(this does not apply to bulkheads or rlprep revetments). (If you wish to waive the setback, you must slan
the appropriate blank below.)
100 wish to waive some/all of the 1 T setback
-OR-Signature ofAc:iacent RipariRiparianProperty owner
I do not wish to waive the 15' setback requirement (initial the blank),1/1
Signature of Adjacent Riparian Property Owner:
Typadll2drdad name of ARPO:
Mailing Address of ARPO: _ L o Boy- 30D Eo4, 4a,, IL16 ?71 3 Z
ARPO's *mail: moore_ 0—e4i•••RPO's Phone#-421,u(-8'8o`I
Dale: I 2422 `waiver Is valid for up to one year from ARPO's Signature•
Revised May 2021

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONMAWER FORM
CERTIFIED MAIL - ,RETURN RECEIPT REQUE&TED or HAND DELIVE
(Top portion to be completed by owner or their agent)
Name of Property Owner. K-ei+-h AmrY)ort5
Mailing Addroas of Owner. 'b1 0� l.�G✓i 1 (. d I� G Z-1_9 3 Z
owner'ssmall:
a aM�yro,�S�f OwnersPhoned - >2-�-r
Agent's Name: Agent Phone:
ADJACENT RIPARIAN PROPERTY OWNS
(Bottom portion to be completed by the Adi
I hereby oerttfy that I own property adjacent to the above reference
permit has described to me, as shown on the attached drawlK
descripb2a or drawing, with dimensions. must be provided with C
i DO NOT have objections to this proposal. 1 I
IN
If you have objections to what Is being proposed, you im
Management (DCAO in writing within 10 days of rcoolpt of t
mailed to 401 S. GrOn St., Ste, 300, Elizabeth Clty, NC, 27 s
contacted at (252) 2"3901. No response is considered the
nodfled by Cart f/ed Mall.1-1ce x
WAIVER SECTION
I understand that any proposed pier, dock, mooring pilings, boat
Fe
a
groin must be set back a minimum distance of 15' from my area
N
(this does not apply to bulkheads or rlprap revetments). (If you v
5. .a
the appropriate blank below.)
3 E
O
I DO wish to walvo somoJall of the 15' Qotbaek
S
Signature atAejXant is
U
3
-OR-
N�= 0 0
I do not wish to waive the 15' setback requirement (inrdaal the bt
E
m C G
(D
Signature of Adjacent Riparian Property Owner:
o 93
Cia�Godr
ry 4-
Typed/Printed nameotARPO: tdwill 4-e-►1oy,)ith
■ ■ ■
Mailing Address of ARPO:.F.O. bcx 2t3 226
31Z&FL^ C201
ARPO's email: ARPO's Phones:
Date: "waiver is valid for up to one yearfrom ARPO's Signature''
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Revised May 2021

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Legend
Untitled Map
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