20120347 Ver 1_Shoreline Stabilization_20120409

2 0 1 2 0 3 4 7
The following is an abbreviated application form for those applying for a 401 Water Quality
Certification to impact FERC (Federal Energy Regulatory Commission) regulated lame shore or
bottom under the U S Army Corps of Engineers Perms P30 Tins Application cannot be used
for wetland or stream impacts. Please provide seven pies of this application and supporting
information as well as a non refundable application fee to the 1hvnsion of Water Quality of $240 00
for impacts of to lake bottom of less than 1 acre and $570 00 for impacts to lake bottom of greater
or equal to 1 acre.
Applications should be sent to
Division of Water Quality 401
1650 Mani Service Center
Raleigh, NC 27699 -1650
Applicant Information
Owner /Applicant Information
Name
Matun€
Mittview Permitting)
rown's ConstructiGii
QI'R 20,? 104 Dogwood Lane
Mt Gilead, NC 27306
R- 910.438-1354
Telephone Number LO `f 'jV 71/ S � b ` Fax Number
E -mail Address
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 Brawn's, Construction
Mailing Address 104 Dogwood Lane
Telephone Number 910+488-1854Fax Number T/O 4 N,-f 9 - I Y s
E -mans Address bb. -c h 6 b ro ad y c c x2 erns 1- '/1 , ;f eT-
II 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 You may use the diagram below to make a
hand sketch of your protect. 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

I Location
County ,��ria'_ Nearest Town
Subdivision name or site address (include phase/lot number)
Directions to site please include road numbers Iandmarks etc (This is not necessary if an adequate
vicinity map is included) _)-Ae /- )'gd6VA&
2 Describe the existing land use or condition of the site at the time of this application
3 Property size (acres)
4 Nearest body of water (stream/nver /sound/ocean/lake) Q A- _
5 Describe the purposp of the�proposeEl work � � t
t
6 List the type of equipment to be used to construct the project r--lrk
7
8 a.
Amount of impact (including all excavation backfill
normal rol lake level
walls etc) below the
Amount of impact (including all clearing back fill excavation, np rap, retaining walls etc )
aboveAhe normal pooldakedevel and 50 feetland --ward iA square feet or acres
r
8 b Please describe vegetation above the normal pool lake level and 50 feet landward to be impacted
(number of trees for instance) J
k% — 1( —
Applicant/Agent s Signature Date
(Agent s signature is valid only if an authorization letter from the applicant is provided )
Brown's Construction
104LDogwood Lane
Mt Gilead, NC27ne
81-1854

own 's Construction
104 Dogwood Lane
Mt Gilead, NC 27306
910439 -1384
Please approximately sketch the following information on this plan
(please provide dimensions for each Item, such as 10 ft. x 100 It):
1) All proposed vegetation clearing (provide dimensions)
.2) location of rip rap or fill to be placed above the Full Pond elevation
3) Location of rip rap or fill to be placed below the Fug Pond elevation
4) The location of any proposed structures such as buildings, retaining
wallso docks, etc.
6) The location of any excavation or dredging below the Full Pond
elevation.
01 Location of construction ,access corridors.
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