20130328 Ver 1_Application_20130328

Brown's Construction
104 Dogwood Lane
Mt Gilead, NC 21306
910 -4WIN4
20130328
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 Corps of Engineers Permit G1130. This Application cannot be used
for wetland or stream impacts. Please provide five (5) copies of this application and supporting
information as well as a non - refundable application fee to the Division of Water Quality of $240.00
for impacts 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 Oversight/Express Review Permitting
1650 Mail Service Center t
Raleigh, NC 27699 -1650
L Applicant'Information
1. owner /Applicant Information
Name:
Mailing Address:
Telephone Number.
E-mail Address:
2. Agent Information (A signed and dated copy of the Agent Authorization
if the Agent has signatory authority for the owner /applicant.)
Name:
Company Affiliation: io4 lnae
Mt Gad N
Mailing Address: 919-w W6 Telephone Number: re W o -A qd u 6 Fax Number.
E -mail Address: 6 �i ro w y a e. e Awl
11. 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 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.
13
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1. Location
County: Nearest Town:
Subdivision name 9site (include phase/lot number):
Directions to site please include road numbers, landmarks, etch.
. I-t}4 - I'r 1
vicinity map is included]:
necessary if an adequate
2. Describe the existing land im or cconditio�p of t�h .siite at the time of this application:
3. Property size (acres): ! 61 ! «+ '
4. Nearest body of water (streandriver/sound/OCean lake):
5. Describe the propose of the proposed work:
6.
7.
8.a
List the type of equipment to be used to construct the project:
Amount of impact (including all excavation, backfill,
Amount of impact (including all clearing, back fill, excavation, rip rap, retaining walls, etc.)
above the nopal pool lake vel gd, 50 feet Iannd -ward r�'njsquayM o; acr .s: e-r— . .
✓ 12;x / -7 -+
8.b. please describe vegetation above the normal pool lake level and 50 feet landward to be impacted
(number of trees for instance):
_s I -s
Applicant/Agent's Signature Date
(Agent's signature is valid only if an authorization letter from the applicant is provided)
Bmwulwledwfiuctipil
M Dogwood Lane
Mt Oil" NCA"M
910143WOM

I of 1
Brown's Construction
104 Dogwood Lane
Mt Gilead N.0 27306
910-439 -1384
3 -19-13
This permit request is for the construction of a treated lumber sea-wall to be constructed
in front of the present sea-wall which the shor�elln�e and the newlsea- wane, and riff sea-wall
have 2 inch stone placed between
the lake side of the seawall. To meet Progress Energy specifications.
Thank You.
\ AIO w �
Butch Brown. I

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3-13 -13
Br ownse conevuedon
104
Nit Gilead N.C. 27306
910.439 -1384
i Nancy L Hancock give Dutch :dU Brown's Construtfion my
permission to ad as my a secg permission, permits arid
CO nffi�rtxfion to be dorm at 459 Shams Rd Mt GiIead iV. C.
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