20071519 Ver 1_Application_20070907

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STATE OF NORTH CAROLINA
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v MICHAEL F. EASLEY LYNDO TIPPETT
GOVERNOR SECRETARY
August 31, 2007
U. S. Army Corps of Engineers
Regulatory Field Office
6508 Falls of Neuse Road
Raleigh, NC 27615 0 715 19
ATTN: Mr. Monte Matthews
NCDOT Coordinator
SUBJECT: Nationwide 13 and 33 Permit Application for the proposed
replacement of Bridge No. 117 over North Fork New River on SR
1118.Ashe County, Federal Project No. BRZ-1118(3), WBS
Element 33380.1.1, T.I.P. No. B-4012.
Dear Mr. Matthews:
Please find enclosed aPre-construction notification, half.-size design plans, and permit
drawings for the above referenced project. The North Carolina Department of
Transportation (NCDOT) plans to replace Bridge No. 117 over the North Fork of the
New River with a new l I5 foot long, 31 foot wide structure on the existing alignment.
Traffic will use a temporary onsite detour to the south of the existing structure during
construction. Project impacts consist of 23 feet of permanent stream impacts, 0.02 acre
of temporary stream impacts, and 0.01 acre of temporary wetland impacts.
IMPACTS TO WATERS OF THE UNITED STATES
General Description: The project is located in the New River basin (HUC 05050001)
and will impact North Fork of the New River and anon-riverine wetland. The wetland is
classified as a Palustrine-forested-broad leafed deciduous, saturated, according to the
Cowardin Wetland Classification System. North Fork of the New River (Index # 10-2-
(1)) is assigned a best usage classification of C Tr+, by the N.C. Division of Water
Quality (DWQ). North Fork of the New River is not designated as a North Carolina
Natural or Scenic River, or as a National Wild and Scenic River, nor is it listed on the
2006 Final 303(d) list. No designated Outstanding Resource Waters (ORW), High
Quality Water (HQW), Water Supply I (WS-I), or Water Supply II (WS-II) waters occur
within 1.0 mile of the project study area. The project does not drain to a 303(d) stream
within one mile of the project limits. The North Fork New River is classified as a
hatchery supported trout river by the NC Wildlife Resources Commission (WRC).
MAILING ADDRESS: TELEPHONE: [phone] LOCAT[ON:
NC DEPARTMENT OP TRANSPORTATION FAX: [phone]$ CAPITAL BLVD
PROJECT DEVELOPMENT AND ENVIRONMENTAL ANALYSIS SUITE 240
1$98 MAIL SERVICE CENTER RALEIGH, NC 27604
RALEIGH NC 27699-154$ WEBSITE: WWW.NCDOT.ORG

Temporary Impacts: Temporary impacts to surface waters consist of 0.02 acre, from the
removal of the old bridge abutment. Temporary impacts to wetlands consist of 0.01 acre
due to the clearing of vegetation and placement of the temporary bridge over the wetland.
After construction of the permanent bridge the temporary bridge will be removed and the
wetland will be replanted.
Permanent Impacts: Permanent stream impacts tota123 feet from the placement of Class
B riprap on the banks of North Fork of New River at the outlet of the V-ditch located in
the northwestern quadrant. Riprap will be placed to prevent erosion on the stream bank
from water discharging from the V-ditch.
Utility Impacts: No impacts will occur due to utility relocations.
Restoration Plan: All materials used as temporary fill in the construction of the detour
structure will be removed and restored to the original contours.
PROJECT SCHEDULE
The project is scheduled to let February 19, 2008 and has a review date of January 1,
2008.
BRIDGE DEMOLITION
Bridge No. 117 is composed of timber caps, posts and sills. Removal of the old bridge is
not expected to permanently or temporarily impact North Fork New River. Best
Management Practice's for Bridge Demolition and Removal will be followed in addition
to Best Management Practices for the Protection of Surface Waters.
HISTORIC ARCHITECTURE
The proposed bridge project is located .within the Sutherland Rural Historic District,
which is eligible for listing in the National Register of Historic Places. A map of the
historic district boundaries is located in Appendix C of the attached CE. FHWA,
NCDOT and the State Historic Preservation Office (HPO) determined that the project
will have "No Adverse Effect" on the National Register-eligible Sutherland Rural
Historic District if NCDOT adheres to the conditions listed on the Concurrence form
dated April 21, 2004. These conditions have been added to the Project Commitment
Sheet in the CE and are listed below in the Avoidance and Minimization Section of this
cover letter.
FEDERALLY-PROTECTED SPECIES
Plants and animals with federal classifications of Endangered, Threatened, Proposed
Endangered, and Proposed Threatened are protected under provisions of Section 7 and
Section 9 of the Endangered Species Act of 1973, as amended. As of May 10, 2007, the
Fish and Wildlife Service (FWS) lists seven federally protected species for Ashe County.
The bog turtle is listed as threatened due to similarity of appearance and therefore does
not require a biological conclusion. A biological conclusion of "No Effect" has been
reached for all other federally protected species in the attached CE. All biological
Page 2

conclusions in the CE remain valid. Surveys for the Virginia spiraea were updated on
June 27, 2007 and no specimens were found.
Federally Protected Sneciec of Aehp f n.~r,t-o
Scientific Name Common Name Federal
Status Biological
Conclusion Habitat
Present
Clemmys muhlenbergii Southern Bog Turtle T (S/A) NA No
Liatris helleri Heller's Blazing Star T No Effect No
Hedyotis purpurea var.
montana Roan Mountain Bluet E No Effect No
Geum radiatum Spreading Avens E No Effect No
Helonias bullata Swamp Pink T No Effect No
spiraea virginiana Virginia Spiraea T No Effect Yes
Gymnoderma lineare Rock Gnome Lichen E No Effect No
AVOIDANCE AND MINIMIZATION
The NCDOT is committed to incorporating all reasonable and practicable design features
to avoid and minimize jurisdictional impacts, and to provide full compensatory mitigation
of all remaining, unavoidable jurisdictional impacts. Avoidance measures were taken
during the planning and NEPA compliance stages; minimization measures were
incorporated as part of the project design and include:
• The new bridge will completely span the channel.
• NCDOT will adhere to Design Standards in Sensitive Watersheds.
• In stream construction will be prohibited from October 15 to April 15 to avoid
impacts on trout reproduction.
• The permanent bridge and roadway have been designed within the 60-foot right-of
way.
• The temporary on-site detour will be constructed utilizing a 35-mph design speed and
located within the temporary construction easements on the southwest side of the
existing bridge.
• The temporary bridge and roadway approaches for the onsite detour will be removed
upon completion of the permanent bridge and roadway. The area disturbed by the
temporary on-site detour, which involves mostly temporary bridge and fill material,
will be restored back to its natural state. The restoration will include the planting of
indigenous trees to replace the ones cut.
• The proposed bridge rail will be a standard two-bar metal rail.
MITIGATION
Mitigation is not proposed because permanent impacts are minimal and are due to the
placement of riprap on the banks of the North Fork New River, not in the stream bed.
REGULATORY APPROVALS
Section 404 Permit: This project has been processed by the Federal Highway
Administration as a "Categorical Exclusion." The NCDOT hereby request a Nationwide
Page 3

Permit 13 for the placement of riprap on the banks of the North Fork of the New River.
The NCDOT requests that the temporary activities associated with removal of the old
bridge and construction of the detour bridge be authorized by Nationwide Permit 33.
Section 401 Permit: NCDOT is hereby applying fora 401 Water Quality Certification
from DWQ. We anticipate 401 General Certification number 3626 and 3634 will apply to
this project. All general conditions of the Water Quality Certifications will be met.
Therefore, in accordance with 15A NCAC 2H, Section .0500(a), we are providing two
copies of this application to the DWQ for their notification.
We anticipate that comments from WRC will be requested prior to authorization by the
Army Corps of Engineers. By copy of this letter and attachment, NCDOT hereby
requests WRC review and that WRC forward their comments to the Corps of Engineers
and NCDOT within 30 calendar days of receipt of this application.
Thank you for your assistance with this project. If you have any questions or need
additional information, please contact Brett Feulner at [e-mail] or
[phone].
A copy of this permit application will be posted on the DOT website at:
http://www.ncdot. orgJdoh/preconstruct/pe/neu/permit.html.
Sincerel ,
~~
~/ Gregory J. Thorpe, Ph.D. Environmental Management Director,
Project Development and Environmental Analysis Branch
cc: w/attachment
Mr. John Hennessy, NCDWQ (2 Copies)
Ms. Marla Chambers, NCWRC
Ms. Marella Buncick, USFWS
Mr. Victor Barbour, P.E. Project Services
Mr. Michael Pettyjohn, P.E. Division 111=
Dr. David Chang, P.E., Hydraulics
Mr. Mark Staley, Roadside Environmental
Mr. Greg Perfetti, P.E., Structure Design
Mr. Heath Slaughter, Div 11 DEO
ingineer
w/o attachment
Mr. Art McMillan, P.E., Highway Design Mr. Jay Bennett, P.E., Roadway Design
Mr. Majed Alghandour, P.E., Prog. and TIP Mr. Scott McLendon, USAGE, Wilmington
Ms. April Johnson, PDEA
Page 4

Office Use Only: Form Version March OS
USACE Action ID No. DWQ No. 2 ~ ~ 7 1 5 1 9
(1t any particular item is not applicable to this project, please enter "Not Applicable" or "N/A".)
I. Processing
Check all of the approval(s) requested for this project:
® Section 404 Permit ^ Riparian or Watershed Buffer Rules
^ Section 10 Permit ^ Isolated Wetland Permit from DWQ
^ 401 Water Quality Certification ^ Express 401 Water Quality Certification
2. Nationwide, Regional or General Permit Number(s) Requested: NW 13 & 33
3. If this notification is solely a courtesy copy because written approval for the 401 Certification
is not required, check here:
4. If payment into the North Carolina Ecosystem Enhancement Program (NCEEP) is proposed
for mitigation of impacts, attach the acceptance letter from NCEEP, complete section VIII,
and check here: ^
If your project is located in any of North Carolina's twenty coastal counties (listed on page
4), and the project is within a North Carolina Division of Coastal Management Area of
Environmental Concern (see the top of page 2 for further details), check here: ^
II. Applicant Information
Owner/Applicant Information
Name: Gregory J. Thorpe Ph.D. Environmental Management Director
Mailing Address: 1598 Mail Service Center
Raleigh, NC 27699
Telephone Number: [phone] Fax Number:_(919) 733-9794
E-mail Address:_ _ gthorpendot.state.nc.us
2. Agent/Consultant Information (A signed and dated copy of the Agent Authorization letter
must be attached if the Agent has signatory authority for the owner/applicant.)
Name:
Company Affiliation:
Mailing Address:
Telephone Number: Fax Number:
E-mail Address:
Page 1 of 8

III. Project Information
Attach a vicinity map clearly showing the location of the property with respect to local
landmarks such as towns, rivers, and roads. Also provide a detailed site plan showing property
boundaries and development plans in relation to surrounding properties. Both the vicinity map
and site plan must include a scale and north arrow. The specific footprints of all buildings,
impervious surfaces, or other facilities must be included. If possible, the maps and plans should
include the appropriate USGS Topographic Quad Map and NRCS Soil Survey with the property
boundaries outlined. Plan drawings, or other maps maybe included at the applicant's discretion,
so long as the property is clearly defined. For administrative and distribution purposes, the
USACE requires information to be submitted on sheets no larger than 11 by 17-inch format;
however, DWQ may accept paperwork of any size. DWQ prefers full-size construction
drawings rather than a sequential sheet version of the full-size plans. If full-size plans are
reduced to a small scale such that the final version is illegible, the applicant will be informed that
the project has been placed on hold until decipherable maps are provided.
1. Name of project: Replacement of Bride No. 117 over North Fork New River
2. T.I.P. Project Number or State Project Number (NCDOT Only): B-4012
3. Property Identification Number (Tax PIN): N/A
4. Location
County: Ashe Nearest Town: Sutherland
Subdivision name (include phase/lot number): N/A
Directions to site (include road numbers/names, landmarks, etc.): The site is located at the
crossing of SR 1118 over North Fork New River
5. Site coordinates (For linear projects, such as a road or utility line, attach a sheet that
separately lists the coordinates for each crossing of a distinct waterbody.)
Decimal Degrees (6 digits minimum): 36.3868 °N 81.6825 °W
6. Property size (acres): N/A
7. Name of nearest receiving body of water: North Fork New River
8. River Basin: New River
(Note -this must be one. of North Carolina's seventeen designated major river basins. The
River Basin map is available at httn://h2o.enr.state.nc.us/admin/maps/.)
9. Describe the existing conditions on the site and general land use in the vicinity of the project
at the time of this application: Forestland
Page 2 of 8

10. Describe the overall project in detail, including the type of equipment to be used:
Standard DOT construction a ui ment.
11. Explain the purpose of the proposed work: The purpose is to replace the old bridge that is
functionally obsolete and structurally deficient.
IV. Prior Project History
If jurisdictional determinations and/or permits have been requested and/or obtained for this
project (including all prior phases of the same subdivision) in the past, please explain. Include
the USACE Action ID Number, DWQ Project Number, application date, and date permits and
certifications were issued or withdrawn. Provide photocopies of previously issued permits,
certifications or other useful information. Describe previously approved wetland, stream and
buffer impacts, along with associated mitigation (where applicable). If this is a NCDOT project,
list and describe permits issued for prior segments of the same T.I.P. project, along with
construction schedules. JD was conducted on August 27, 2002 (USACE ID 200220728_
V. Future Project Plans
Are any future permit requests anticipated for this project? If so, describe the anticipated work,
and provide justification for the exclusion of this work from the current application.
VI. Proposed Impacts to Waters of the United States/Waters of the State
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
wetlands, open water, and stream channels associated with the project. Each impact must be
listed separately in the tables below (e.g., culvert installation should be listed separately from
riprap dissipater pads). Be sure to indicate if an impact is temporary. All proposed impacts,
permanent and temporary, must be listed, and must be labeled and clearly identifiable on an
accompanying site plan. All wetlands and waters, and all streams (intermittent and perennial)
should be shown on a delineation map, whether or not impacts are proposed to these systems.
Wetland and stream evaluation and delineation forms should be included as appropriate.
Photographs maybe included at the applicant's discretion. If this proposed impact is strictly for
wetland or stream mitigation, list and describe the impact in Section VIII below. If additional
space is needed for listing or description, please attach a separate sheet.
Page 3 of 8

1. Provide a written description of the proposed impacts: The project impacts are as
follows, 23 feet (0.01 acre) of permanent stream impacts, 48 feet (0.02 acre) of temporary
stream impacts, and 0.01 acre of temporary wetland impacts
2. Individually list wetland impacts. Types of impacts include, but are not limited to
mechanized clearing, grading, fill, excavation, flooding, ditching/drainage, etc. For dams,
separately list impacts due to both structure and flooding.
Wetland Impact Type of Wetland Located within Distance to Area of
Site Number Type of Impact (e.g., forested, marsh, 100-year Nearest Impact
(indicate on map) herbaceous, bog, etc.) Floodplain Stream (acres)
( es/no) (linear feet
Site 1 Temporary Forested yes adjacent 0.01

Total Wetland Impact (acres) 0.01
3. List the total acreage (estimated) of all existing wetlands on the property: 0.01
4. Individually list all intermittent and perennial stream impacts. Be sure to identify temporary
impacts. Stream impacts include, but are not limited to placement of fill or culverts, dam
construction, flooding, relocation, stabilization activities (e.g., cement walls, rip-rap, crib
walls, gabions, etc.), excavation, ditching/straightening, etc. If stream relocation is proposed,
plans and profiles showing the linear footprint for both the original and relocated streams
must be included. To calculate acreage, multi ly length X width, then divide by 43,560.
Stream Impact
Perennial or Average Impact Area of
Number Stream Name Type of Impact
Intermittent? Stream Width Length Impact
(indicate on map) Before Impact (linear feet) (acres)
Site 1 North Fork New Temporary Perennial 25 48 0.02
River
Site 1 North Fork New permanent Perennial 25 23 0.01
River

Total Stream Impact (by length and acreage) 71 0.03
5. Individually list all open water impacts (including lakes, ponds, estuaries; sounds, Atlantic
Ocean and any other water of the U.S.). Open water impacts include, but are not limited to
fill, excavation, dredging, flooding, drainage, bulkheads, etc.
Open Water Impact

Site Number
(indicate on ma)
Name of Waterbody
(if applicable)

Type of Impact Type of Waterbody

(lake, pond, estuary, sound, bay,
ocean, etc.) Area of

Impact
acres)

Total Open Water Impact (acres)
6. List tl
ie cumulative im act to all Waters of the U.S. resulting from the roject
Stream Impact (acres): 0.03
Wetland Impact (acres): 0.01
Page 4 of 8

Open Water Impact (acres): 0
Total Impact to Waters of the U.S. (acres) 0.04
Total Stream Impact (linear feet): 71
7. Isolated Waters
Do any isolated waters exist on the property? ^ Yes ®No
Describe all impacts to isolated waters, and include the type of water (wetland or stream) and
the size of the proposed impact (acres or linear feet). Please note that this section only
applies to waters that have specifically been determined to be isolated by the USACE.
8. Pond Creation
If construction of a pond is proposed, associated wetland and stream impacts should be
included above in the wetland and stream impact sections. Also, the proposed pond should
be described here and illustrated on any maps included with this application.
Pond to be created in (check all that apply): ^ uplands ^ stream ^ wetlands
Describe the method of construction (e.g., dam/embankment, excavation, installation of
draw-down valve or spillway, etc.):
Proposed use or purpose of pond (e.g., livestock watering, irrigation, aesthetic, trout pond,
local stormwater requirement, etc.):
Current land use in the vicinity of the pond:
Size of watershed draining to pond: Expected pond surface area:
VII. Impact Justification (Avoidance and Minimization)
Specifically describe measures taken to avoid the proposed impacts. It may be useful to provide
information related to site constraints such as topography, building ordinances, accessibility, and
financial viability of the project. The applicant may attach drawings of alternative, lower-impact
site layouts, and explain why these design options were not feasible. Also discuss how impacts
were minimized once the desired site plan was developed. If applicable, discuss construction
techniques to be followed during construction to reduce impacts. Best management Practices for
the protection of Surface Waters and BMP's for Bridge demolition and removal, a trout
moratorium will be observed and the proposed bridge will span the creek
VIII. Mitigation
DWQ - In accordance with 15A NCAC 2H .0500, mitigation may be required by the NC
Division of Water Quality for projects involving greater than or equal to one acre of impacts to
freshwater wetlands or greater than or equal to 150 linear feet of total impacts to perennial
streams.
USACE - In accordance with the Final Notice of Issuance and Modification of Nationwide
Permits, published in the Federal Register on January 15, 2002, mitigation will be required when
Page 5 of 8

necessary to ensure that adverse effects to the aquatic environment are minimal. Factors
including size and type of proposed impact and function and relative value of the impacted
aquatic resource will be considered in determining acceptability of appropriate and practicable
mitigation as proposed. Examples of mitigation that maybe appropriate and practicable include,
but are not limited to: reducing the size of the project; establishing and maintaining wetland
and/or upland vegetated buffers to protect open waters such as streams; and replacing losses of
aquatic resource functions and values by creating, restoring, enhancing, or preserving similar
functions and values, preferable in the same watershed.
If mitigation is required for this project, a copy of the mitigation plan must be attached in order
for USACE or DWQ to consider the application complete for processing. Any application
lacking a required mitigation plan or NCEEP concurrence shall be placed on hold as incomplete.
An applicant may also choose to review the current guidelines for stream restoration in DWQ's
Draft Technical Guide for Stream Work in North Carolina, available at
http://h2o. enr.state.nc.us/ncwetlands/strmgide.html.
1. Provide a brief description of the proposed mitigation plan. The description should provide
as much information as possible, including, but not limited to: site location (attach directions
and/or map, if offsite), affected stream and river basin, type and amount (acreage/linear feet)
of mitigation proposed (restoration, enhancement, creation, or preservation), a plan view,
preservation mechanism (e.g., deed restrictions, conservation easement, etc.), and a
description of the current site conditions and proposed method of construction. Please attach
a separate sheet if more space is needed.
No mitigation is proposed because the proposed impacts are minimal.
2. Mitigation may also be made by payment into the North Carolina Ecosystem Enhancement
Program (NCEEP). Please note it is the applicant's responsibility to contact the NCEEP at
[phone] to determine availability, and written approval from the NCEEP indicating
that they are will to accept payment for the mitigation must be attached to this form. For
additional information regarding the application process for the NCEEP, check the NCEEP
website at http://h2o.enr.state.nc.us/wrp/index.htm. If use of the NCEEP is proposed, please
check the appropriate box on page five and provide the following information:
Amount of stream mitigation requested (linear feet):
Amount of buffer mitigation requested (square feet):
Amount of Riparian wetland mitigation requested (acres):
Amount ofNon-riparian wetland mitigation requested (acres):
Amount of Coastal wetland mitigation requested (acres):
IX. Environmental Documentation (required by DWQ)
Does the project involve an expenditure of public (federal/state/local) funds or the use of
public (federal/state) land? Yes ® No ^
Page 6 of 8

2. If yes, does the project require preparation of an environmental document pursuant to the
requirements of the National or North Carolina Environmental Policy Act (NEPA/SEPA)?
Note: If you are not sure whether a NEPA/SEPA document is required, call the SEPA
coordinator at [phone] to review current thresholds for environmental documentation.
Yes ® No ^
3. If yes, has the document review been finalized by the State Clearinghouse? If so, please
attach a copy of the NEPA or SEPA final approval letter. Yes ® No ^
X. Proposed Impacts on Riparian and Watershed Buffers (required by DWQ)
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
required state and local buffers associated with the project. The applicant must also provide
justification for these impacts in Section VII above. All proposed impacts must be listed herein,
and must be clearly identifiable on the accompanying site plan. All buffers must be shown on a
map, whether or not impacts are proposed to the buffers. Correspondence from the DWQ
Regional Office may be included as appropriate. Photographs may also be included at the
applicant's discretion.
1. Will the project impact protected riparian buffers identified within 15A NCAC 2B .0233
(Meuse), 15A NCAC 2B .0259 (Tar-Pamlico), 15A NCAC 02B .0243 (Catawba) 15A NCAC
2B .0250 (Randleman Rules and Water Supply Buffer Requirements), or other (please
identify )? Yes ^ No
2. If "yes", identify the square feet and acreage of impact to each zone of the riparian buffers.
If buffer mitigation is required calculate the required amount of mitigation by applying the
buffer multipliers.
Zone* Impact
(s uare feet) Multiplier Required
Miti ation
1 3 (2 for Catawba)
2 1.5
Total
- cone i extenas out su teet petpendtcutar from the top oY the near bank of channel; Zone 2 extends an
additiona120 feet from the edge of Zone 1.
3. If buffer mitigation is required, please discuss what type of mitigation is proposed (i.e.,
Donation of Property, Riparian Buffer Restoration /Enhancement, or Payment into the
Riparian Buffer Restoration Fund). Please attach all appropriate information as identified
within 15A NCAC 2B .0242 or .0244, or .0260.
XI. Stormwater (required by DWQ)
Describe impervious acreage (existing and proposed) versus total acreage on the site. Discuss
Stormwater controls proposed in order to protect surface waters and wetlands downstream from
Page 7 of 8

the property. If percent impervious surface exceeds 20%, please provide calculations
demonstrating total proposed impervious level. Approximately the same as current conditions
XII. Sewage Disposal (required by DWQ)
Clearly detail the ultimate treatment methods and disposition (non-discharge or discharge) of
wastewater generated from the proposed project, or available capacity of the subject facility.
XIII. Violations (required by DWQ)
Is this site in violation of DWQ Wetland Rules (15A NCAC 2H .0500) or any Buffer Rules?
Yes ^ No
Is this an a$er-the-fact permit application? Yes ^ No
XIV. Cumulative Impacts (required by DWQ)
Will this project (based on past and reasonably anticipated future impacts) result in additional
development, which could impact nearby downstream water quality? Yes ^ No
If yes, please submit a qualitative or quantitative cumulative impact analysis in accordance with
the most recent North Carolina Division of Water Quality policy posted on our website at
http://h2o.enr.state.nc.us/ncwetlands. If no, please provide a short narrative description:
Replace an existing structure
XV. Other Circumstances (Optional):
It is the applicant's responsibility to submit the application sufficiently in advance of desired
construction dates to allow processing time for these permits. However, an applicant may
choose to list constraints associated with construction or sequencing that may impose limits on
work schedules (e.g., draw-down schedules for lakes, dates associated with Endangered and
Threatened Species, accessibility problems, or other issues outside of the applicant's control).
~' ~' V
Apf~ilica~f/Agent's Signature Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
Page 8 of 8

9:59:06 AM
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NAMES AND ADDRESSES
PARCEL N®.
NA1~IE5
ADDRESSES
SARAH, JOSEPH, FRANK NEAL
3
GRANT A. SUTHERLAND
P.®. B®X 1~~1
JEFFERS®N, NC 28640
1000 SUTHERLAND RD
CREST®N, NC 28615