20110244 Ver 1_Shoreline Stabilization_20110314

The following is an abbreviated application form for those applying for a 401 Water Quality
Certification to impact FERC (Federal Energy Regulatory commission) regulated lake shore or
bottom under the U.S. Army Corp of Engineers Permit GP30 This Application cannot be used
for wetland or stream impacts. Please provide seven (7) copies of this application and supporting
information as well as a non-rdkmdable application fee to the Division of Water Quality of $240,00
for impacts of to lake bottom of less than 1 acre and $570.00 for
or equal to 1 acre. impacts to lake bottom of greater
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Applications should be sent to: 20 1 10 2 4 4 ? A
Division of Water Quality 401 Oversight/Express Review Permitting
1654 Man service center kN f
Raleigh, NC 27699-1650
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1. Applicant f
Information
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?Owner/Applicant Information
Name: _ A,- `I Eir aLp U-(-
Mailing Address: ?o 50 Y_ 1133
Telephone Number: 33& 29-1 674E6 Fax Number. S9 3Z[
E-mail Address: _G r Ic.? r (' ( -- 6 u i I d i K a. Garr,
-11 ? 2• Agent 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: _
11. Project Wormation
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. You may use the diagram below to make a
hand sketch of your project. Also, see the example below for guidance. Both the vicinity map and site
plan must include a scale and north arrow. The footprints of all buildings, impervious surfaces, or other
facilities must be included.
1. Location.
County: _P.rSo?l
Nearest Town:
Subdivision name or site address (include phase/lot number): LOT tp 7, t,I
Directions to site please include road numbers, landmarks, etc . (This is not necessary if an adequate
vicinity reap is included): Ir=ran^? --W-
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2. Describe the existing land use or condition of the site at the time of this plication: p 'd G si
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3. Property size (acres): 0.70
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4. Nearest body of water (stream/river/sound/ocean/lake): /4`/'Go
5. Describe the purpose of the proposed work: TD STGia ERvs < c,v o?
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6. List the type of equipment to be used to construct the project: alb Ss
7. Amount of impact (including all excavation, backfll, rip rap, retaining walls, etc.) below the
normal pool lake level in square feet or acres:
8.a. Amount of impact (including all clearing, back fill, excavation, rip rap, retaining walls, etc.)
above the normal pool lake level and 50 feet land-ward in square feet or acres:
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8.b. P;casc describe vegetation above the normal pool lake level and 50 feet landward to be impacted
(number of trees for instance):
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AppltcantlAgent's Signature Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
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