20200651 Ver 1_Shoreline Stabilization_20200518

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 5/18/2020 4:03:21 PM (Submittal)
Approve by Montalvo, Sheri A 5/18/2020 11:23:45 PM (Non -DOT - Approver)
• The task was assigned to Montalvo, Sheri A 5/18/2020 4:03 PM

Submission Form
I. Applicant Information [15A NCAC 02H .0502(a)]
Please note: fields marked with a red asterisk below are required. You will not be able to submit the form until all
mandatory questions are answered.
Owner Information:
Name: *
Email:*
Phone Number:*
Mailing Address:*
Is there an agent working on the
project?*
Agent/Consultant Information
Name:*
Company Affiliation:*
Email:
Phone Number:*
Stephen Hotlzman & Yung Fong -Sung Hotltzman
[e-mail]
[phone]
(xxx)xxx-xxxx
Street Address
6424 Huntington Lane
Address Line 2
City
Conover
Fbstal / Zip Code
28613
r Yes
r No
Mickey Larson
Owner/ LKN PERMITS, LLC
[e-mail]
[phone]
(xxx)xxx-xxxx
State / Rovince / Fbgion
NC
Country
USA

Mailing Address:*
Street Address
4688 Mtn. Creek Ave
Address Line 2
city
Denver
Fbstal / Zip Code
28037
Asigned and dated copyof the Agent Authorization letter:*
Holtzman Auth Form.pdf 1.71VIB
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
.................................................................................................................................................................................................................................
Project Name:* Stephen Holtzman, Yung Fong- Sung- Holtzman
State / Rovince / Region
NC
Country
US
If your project has a formal name please use this. If your project does not have a formal name, please identify your project by
the owner name and proposed activity (Jones Property Access Road, Smith Guest House, etc.) List in parentheses any
other names that have been used to identify the project in the past.
1. Provide a vicinity map (i.e. street map) clearly showing the location of the property with respect
to local landmarks such as towns, rivers, and roads. *
f Upload File
r Lookup address
Property Address Lookup:* Street Address
6424 Huntington Lane
Address Line 2
City State / Frovince / Pegion
Conover NC
Fbstal / Zip Code Country
28613-7754 US
Latitude:* 35.811139 Longitude:*-81.218771
2. Provide a detailed site plan showing property boundaries and proposed locations of vegetation clearing,
structures (buildings, retaining walls, docks, impervious surfaces, etc.), rip rap, excavation or dredging
below Full Pond/ Normal Water Level elevations, and construction access corridors. You may use the
diagram under section 12.normal pool lake level/normal water level*
Hotlzman Photos.pdf 17.21 MB
Please use the diagram at the link below:
https://edocs.deq.nc.gov/WaterResources/O/edoc/616616/Shoreline%2OLayout.docx
3. Attach a photograph of the shoreline/ buffer proposed to be stabilized. (Include a scale of some sort- a
yard stick, shovel handle, etc.)*
Hotlzman Photos.pdf 17.21 MB
4. Location of the property (where work is to be conducted)
Nearest Town:* Conover
County:* Catawba

Lake/ river/ ocean adjacent to Norman
property:
Subdivisions name or site address:* Lot 4
Include phase/lot nunber
Directions to site:*
Follow Sherrills Ford Rd to Lowrance Rd in Catawba
Turn R onto NC 150 W
Turn R onto Sherrills Ford Rd
Turn R onto Lowrance Rd
Turn R onto 2nd Ave SW
Turn L onto Main St
Turn L to stay on Oxford School Rd
Turn R onto NC 16 N
Slight L onto Springs Rd
Turn R onto Lee Cline Rd
Turn R onto St Peters Church Rd
Turn L onto Huntington Lane
Rease include road naves and numbers, landmarks etc.
5. Describe the existing land use or condition of the site at the time of this application:*
Residential Shoreline, eroding
Fbsidential, undeveloped, etc.
6. Property Size 2.3
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary):
Deliver and Install Class B Rip/Rap by Barge to stabilize Shoreline
and Prevent further erosion.
8. How will the work be done?* r From Land
17 From Water
9. Total amount of disturbance below the normal pool lake level/ normal water level:*
(including all clearing, backfill, excavation, rip rap, retaining walls, etc.)
4
square feet
10. Total amount of disturbance above the normal pool lake level/ normal water level and 50 feet
land -ward: *
(including all clearing, back fill, excavation, rip rap, retaining walls, etc.)
4
square feet
11. Please describe the vegetation above the normal pool lake level/ normal water level and 50 feet
landward to be impacted:*
(nunber of trees, for instance)
Soil, Rock, decomposed trees
Sketch: Hotlzman Photos.pdf 17.21 MB
Application Fee:
Once the application has been accepted. You will need to send a corresponding fee in with the appropriate DWR#. The
application fee is as follows (pursuant to G.S. 143-215.3D):
o $240.00 for impacts to lake (below normal water level) of less than 1 acre
o $570.00 for impacts to lake (below normal water level) of greater or equal to 1 acre

By digitally signing below, I certify that:
• I have given true, accurate, and complete information on this form;
• I agree that submission of this form is a "transaction" subject to Chapter 66, Article 40 of the NC General Statutes (the
"Uniform Electronic Transactions Act")
• I agree to conduct this transaction by electronic means pursuant to Chapter 66, Article 40 of the NC General Statutes
(the "Uniform Electronic Transactions Act');
• I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written
signature; AND
o I intend to electronically sign and submit this form.
Full Name:* Mickey Larson
Signature:

Initial Review
Is this accepted into the review
process?*
Project Number:* 20200651
Select Reviewer:*
Select Reviewing Office
Has payment been received?*
What amount is owed?*
r Yes f No
Version:* 1
Alan Johnson:eads\adjohnson1
Mooresville Regional Office - [phone]
r No Payment Needed
f Fee Received
r Need Fee - send electronic notification
* $240.00
f $570.00

y
PROPERTY LEGAL DESCRIP ---I IQNS]W
LOT NO&
STREET ADDRESS:
Please print:
Property owne
Property Owne
AGENT AUTHO-RIZATION -FORM
PLAN NOW Pppmftftffiv�ARCEL ID:
V
I I
wpm
The undersigned, registered property owners of the shove nnted propertyr do hereby authorize
r �r or
(ContracbDr Agent)
vmai i ie uy con5uming term}
to act on my behalf and take all actions necessary far the Processing
this perm -It or cerdfication and any and alb standard and special condi
property Owner's Address (if dIA-fferent than400% - R& property above):
Tetephone:���
0
issuance and
itions attached,,
acceptance of
W-e hereby certify the above info at*ion submitted in this application is true and accurate to the
best of our knOwledge.
uthorolz
DateS,
61
�0(¢ Date:
11
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