SW6211003_Application Form_20211019

CONTACT INFORMATION
a. Print Applicant / Signing official's name and title (specifically the developer, property owner, lessee,
designated governill orit of ficia 1, individual, etc. who —owns the -aw�Lmrt):
Applicant/ Organization: LZhc j s —oi i (., Lo i i 11) —anie.&IL
Signing Official & Title:LaD —JeE nKbn oa a --Ey L'af(IIIA-1-1 U, —0115,
b. Contact information for person listed in item la above:
Street Address: L(L/5-J-_uniV, or Lake Q
G I Y:-W-kAt
Mailing Address (if applicable):
City:
Phone:
L
State: --- Zip:
IM
c. Please check the appropriate box. The applicant listed above is:
Ul-he property owner (Skip to Contact Information, item 3a)
1,essee* (Attach a copy of tyre lease agreement and complete Conlacl Inforniation, itern 2a and 2b below)
Purchaser* (Attach a copy of the pending sales agreenient and conipbote, Contact Iriformation, itern 2a and 2b
below)
Developer* (Complete Contact Information, item 2a and 2b below.)
2. a. Prili l, Properly Owners na rn e and title, be low, if YOU are thc- pure. ws r' or developer. (rhisray tiie
person who owiis the property that the project is located on):
1-1roperty . ..... -
Signing Official & Title:Prop2grt Owner . ..... y_
b. Contact information for person listed in item 2a above:
Street Address:
City: J —Za I e i&l —I State:NC ZiD:27606
Mailing Address (if applicable):
City:
Phone: L ------
Email:
State: —.- Zip:
Fax:
3. a. (Optional) Print the name and title of another contact such as the project's construction supervisor or other
person who can answer questions about the project:
Other Contact Person/ Organization :9h(s!1s-Q1-
Signing Official & Title:Alsin Ca
b. Contact information for person listed in item 3a above:
Mailing Address
City:West ED-d---�
Phone:
State:NC Zip:27376
Fax: (
4. Local jurisdiction for building permits:
Point of ContacQM�,can
is h _A(
n in. Phone#: (910— 1 —876:-1-268
Forrn SWU-101 Version 06Aug2012 Page 2 of 7

IV. PROJECT INFORMATION
1. In the space provided below, brigLy summarize how the stormwater runoff will be treated.
�',� siterilll'rr ca,?t_�tst'k4 . ........... .._
2. a. If claiming vested rights, identify the supporting documents provided and the date they were approved:
yw Approval of a Site Specific Development Plan or PLTD Approval Date:
Issued Date: ........
_ Valid Building Permit IDate. ....._.-...
b.If claiming vested rights, identify thr agu lation(s) the project has been designed in accordance with:
Coastal Si�4°" - 1995 ❑ Ph 11- Post Construction
3. Stormwater runoff from this project drains to the Lumber River basin.
4. Total Property Area: 2.02 acres
5. Total Coastal Wetlands Area: 0 acres
6. Total Surface Water Area: 0 acres
7. Total Property Area (4) - Total Coastal Wetlands Area (5) - Total Surface Water Area (6) = Total Project Area+:
2.02 acres
lblal project area shall be w1rulated it) exclrade the /olloaain : the nunnal ]wadadrl of un uninded slrna`t�ares, the arealad�trocaera llaahaaat cfstaeaarrr Barad °rc�ers, 1Pad°ara*aa lyd�la axa tl�a�carraaal IIl is lhaals�i� ( 1611 line or Mean 1'la'gh l+ir'rater-
(tvPMY) line, and coastal nrellands landward fioin the M9W (or M IN0 line. ` 7je resxallan t droject area rs used to
calcidote overall percent buill upon area 030 ). Non -coastal wetlands landward of the 1Jfl (or a"wlll'W)1hic anaay
be included in the total project area.
8. Project percent of impervious area: (Total Impervious Area / Total Project Area) X 100 = %,
9. How many drainage areas does the project have?1 (For high density, count 1 for each proposed engineered
stormwater BMP. For low density and other projects, use 1 for the whole property area)
10. Complete the fol'lovwing information for each drainage area identified in Project Information uteri % If there
are more than four drainage areas in the project,, attach an additional sheet with the information for each area
provided in the same format as below.
Basin Information
Drainage Area 1
Drainage Area
Drainage Area
Drainage Area
Receiving Stream Name
Raft Swamp
Stream Class "
C:Sw
..._—...
— — .----.._
StreamIndex Number..k......................................_.....14-10-.
....................._..........................................
,_ __.
.._. _..�
—.. ..-.w .
Total Drainage Area (sf)
43549
On -site Drainage Area (sf)
43549
Off -site Drainage Area (sf)
0
Proposed Impervious Area"
34379
(sf)
% Impervious Area** (total)
78.94
Form SWU-101 Version 06Aug2012 Page 3 of 7