20071796 Ver 1_401 Application_20071024

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PAYMEf~T
RECEIVED
The foDowing is an abbreviated application form for hose applying for a 401 water
Quality Certification to impact F~RC (Federal Energy Regulatory Commission}
regalat~ed lake shore or beitaaat Hader the U.S. Army Corps of Engineers Permit
GP30. Tl~a Appl3attian cannot be need fur wetland or stream im~cb. Please
provide se~-en ('7) copies of tLis won and suppar~g infsrmatioa ~ wdt as a
nonarefnadable avian fee fo the Divlaiwo of water Qaa6ty of S20A.00 for
im~atb of t+o Lloe bottom of kss than 1 acre and 54700 for i~scts to lake bottom
of gr+eate~r or equal to 1 acres
Applications shonid be sent to:
Division of water Qualhy wetiands unit
1160117 Service Center
Raleigh, NC 27h99-1650
L Applicant Information
1. OwnetfApplicant
~~ Ny<o ~-ke
gtso Se~ "1a : camel sus-e+4,
x~,3
t~~
~ ~'tl Calms
~ s5ae ~ a Neese ~
saes 120
VVini~glon Diskicl Raleigh, NC 27615.6814
~~~ ~I~~87'6-58,3
~ngurrl
~/
'~- S/
Telepho®~e
~ Adl
- SG o ~- Fax Number: 33~ - 594 - 36
~nS~"«G 4~40~.Gorn
Z. Agent 7nf+o®uation (A signed and da>ard copy of the Agent Author~tin~a lethx
ma4t be if dte Agent has Slgnabor3r authority far the ow~o~adappIicant:)
1Vame:
Marling Address;
t eiepaone lvnmber. Fax Nmnber. --
F.~ai1 Address:

Project Information
Attach a vicinity msP cleatiy showing the locstian of the pmparty with c+espect to
local landmarks sock as bavvns, rivets, 'and roads. Also pmvide a dettnlad site
plea showing pavpeaty boogies and dcvelop~meut plans is relation to
P~P~• Yaa nsaY sae the below to make a hand sketch of
Q~c~~oe@~
ocr z 4 200
OENR -WATER QUALITY
-ti~n~wos Iwo sroRlayq~ swsNCH

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your project. Also, see the example below for guidance. Both the vicinity map and
site plan must include a scale and north arrow. The footlxints of all buildings,
impervious surfaces, or other facilities must be included.
1. Location
County: ~e>r S o r. Neamst To~7t: !Zo xbo r 4
Subdivision nazne or site address (include phase/lot number}: l..a~ rna~•
Directions to site please include road numbest, landmarks, etc. (This is not
necessary if an aCCd--mate vi ty map is included}:_ 1 S -SV l ~ ~c]~f7ord~ T'u,r ~ a ~..~v
t~1 C - S ~ ~ .X Yv1di2. Rd 1 Cn.~ A1aGf Qi\1C ~ ..~ . ~. ~~ -. T.. / .~ ! D.G~ .~ ~ ,~,
M~ irc-
L-~6ir-~~- ~r i vt - Loc®.,~t~ o-~ t L 3 ~.c~.~m.~. r-i t/e
2. Desanbe the ex sting land uge or condition of the site at the time of this
3. Property size (acres): O . ~ '~ /~.~s
4. Nearest body of water (stream/riverlsound/ocean/lake): C~ rt ~~4 c o ~~
5. Describe the purpose of the proposed work: ~~- ~~ - nti Y~..'~73.- n i n1~,c.~
6. List the type of equipment m be used to construct the project: -s K ~ ~ ~e.2 Y ~1-
7. Amount of impact (including all excavation, backfill, .rip rap, retaining welts,
etc.) below the normal pool lake level in square feet or acres:- .~ Soo s 4 ~-
8. a. Amount of impact (including ail clearing, back fill, excevation, rip rap,
retaining walls, etc.) above the normal poo~~" level alai St) Ceet land-ward in
square feet or acres-- I $ b0 S~_ r}-
b. Please describe vegetation above the normal pool lake level and Sl} feet land-
ward to be impacted (number of trees for instance): !1/rm-c-- -~o /LJ, ~j i ~ ~,,~
(Agent's signature is valid only if an authorization letter from the applicant is provided.)

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