67166D - Lee

ICMA / ❑DREDGE & FILL
NERAL PERMIT ✓✓✓ r b Previous permit#
ew ❑Modification ❑Complete Reissue El Partial Reissue Date previous permit issued
ized by the State of North Carolina, Department of Environment and Natural Resources
;oastal Resources Commission in an area of environmental concern pursuant to I SA NCAC t r ` • (/ 1y
❑ Rules attached.
Name Project Location: County AAA 7
Street Address/ State Road/ Lot #(s)
StateZIP (;n 41 LP
(~ yLZI_-_��ail _ Subdivision
:d Agent
❑ Cw
❑ OEA
[Y4W *A ❑ ES ❑ PTS
❑ HHF . ❑ IH ❑ UBA ❑ N/A
❑ PWS:
yes Cno� PNA es no
Project/ Activity i
:k) length
itform(s)
Platform(s)
er(s)
igth
nber
i/ Riprap len h r
distance shore
x distanc offshore
cannel
I 1
sic ds
ip
Aldozing
e Length
not sure yes
cum: n/a yes
no
kttached: no
ng permit X*$e required by:
Local Planning jurisdiction) _,1
City zip
Phone # ( --) "— �'r� River Basin
Adj. Wtr. Body ('Yqlft
Xnat
Closest Maj. Wtr. Body ftWIV
(Scale: I It mw'�
11y t ❑ See note on back reprding River Basin r

NC Division of Coastal Mgt. Habitat Impact Computer Sheet
r
Applicant: i'e�'V� �-� . Permit #:
Date:
Describe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
found in your Habitat code sheet.
TOTAL Sq. Ft. FINAL Sq. Ft. TOTAL Feet FINAL feet
(Applied for. (Anticipated final (Applied for. (Anticipated final
DISTURB TYPE Disturbance total disturbance. Disturbance disturbance.
Habitat Name Choose One includes any Excludes any total includes Excludes any
anticipated restoration any anticipated restoration and/or
restoration or and/or temp restoration or temp impact
(LN1 Dredge ❑ Fill ❑ Both ❑ Other
Dredge ❑ HI ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ FIII ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑ 1 1
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑ 1
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both Q Other ❑
Dredge ❑ Fill 0 Both ❑ Other ❑

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MEMO
Date: 8-11-16
From: Terry Lee
To: Division of Coastal Management
Subject: 710 Alyssum Ave., Caswell Beach
Attached please find my application to:
1. Install pilings for a boatlift adjacent to my existing floating dock
2. Remove and replace rotted pilings from my existing fixed dock and walkway.
Dock originally built in 2001.
I apologize in advance for the quality of my writing and drawing. I have Parkinson's and
my writing and drawing skills left me a long time ago. Let me know if they are too crude
for your use.
Thank you for your help. I hope that everything is suitable. Feel free to call me should
you have a question.
Ter4___
ry Lee
336-451-4298

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to
NAucy L56 's
i ID �11 �� � (Name of Property Owner)
property located at jSsom we I I K.,ch ,y _
� (Address, Lot, Block, Road, etc.)
on F�►�Gq Cree% in �,,:w'_ 11 Trot , tiI� , N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above location.
`l" I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAINING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
lnovt_ R-o Art aJ C-, -Doc*
of ('L A-T" . 'Remove
L-�lsr�4
ZS
P,14 /a
f• RAC
E- WAL.K
to` e6iiru/Aer> -3aAr- L1,cr• eiv CUo, j'ND
A--J-P kgftA6 'RoT7EN PIL/"J*
• • I �caaar
lam, j�,gmr'
/ 1
L <- WALK
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set back
minimum distance of 15' from my area of riparian access unless waived by me. (If you wish to waive
the se ack, 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.
(Property Owner Information) (Adjacent Property Owner Information)
JA
Signatu e Signature
/V AX WiL[-,?AMS _I�qkA 14 bt%ILL MAM

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to
1 L rzl( A J'P A)Aa1 cv L� I
property located at 1 /o A►1sc°", Av�
(Name of Property Owner)
(Address, Lot, Block, Road, etc.)
on rl'Je'� CreeK , in Q: we /i -A.6c , � N.C.
(Waterbody) (City/Town 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)
roC"I , r4,k ,y4► 117o6 K i o' EAvjwAf-D. TAOT .c.e— - oA^+ [_>" Qu &Ucs r FGc qr�
O ��yyyC _j Ovaf nt [L kA5 AMID CLAfx -
7oA-r As ra
AMP
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WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set back
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.
(Prop, rty Owner Information) (Adjacent Property Owner Information)
"C'f2 co-d'L
Signalure Signature
K aoK RFr.FIVED
�Afll r.Alm('.T(N NC

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Caswell Beach City =
November 30, 2015 !�7 ^
1 = 100 Feet / tU
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