20191648 Ver 1_Shoreline Stabilization_20191202

r
State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
15A NCAC 02H .0500 — Water Quality Certification, Shoreline 50-106tion
FORM: SSGV 02-2017
t
Shoreline Stabilization Application Form
Three copies of the application (including attachments) and the application fee should be s nt to:
If sending via US Postal Service If sending via delivery service (UPS, FedEx, etc.)
Karen Higgins Karen Higgins
DWR - 401 & Buffer Permitting Branch DWR - 401 & Buffer Permitting Branch
1617 Mail Service Center 512 N. SalisburyStreet f" .
��V�p�i.lc? �;...'
Raleigh, NC 27699-1617 Raleigh, NC 27604
DEC a 2 2019
A. Applicant Information [15A NCAC 02H .0502(a)j
1. Owner Infoctnation
Name: _L-S"_'
Mailing Address:
Telephone Number: �I'� j lr �l�r"�Y `1'f�; Fax Number:
E-mail Address: {� ,Y�t' _t' �' �' � is ► EL C�
2. Agent/ Contact Person Information
Water RG%-0UrcFi
Mrffe' n9 -%cow
A signed and dated copy of the Agent Authorization letter must be attached if the Agent has
signed this application form. (A form can be downloaded here:
http://www saw usace army mil/Portals/59/docs/regulatory/regdocs/Permits/SAMPLE AGENT AUTHORIZ
ATION FORM. df)
Name: -n w V iC)
Company Affiliation:
Mailing Address:
Telephone Number: (� f' CI) S'Q `jaL6Wax Number:
E-mail Address: 0 '; (-I Lif+ I sh i C C i, ' C:J-
B. Project Information [15A NCAC 02H .OS02(a) & (b)J
1. Attach 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.
2. Provide a detailed site plan showing property boundaries and proposed locations of
vegetation clearing, buildings, retaining walls, docks, impervious surfaces, rip rap, excavation
or dredging below Full Pond/ Normal Water Level elevations, and construction access
corridors. You may use the diagram provided at the end of this application form.
FORM: SSGP 02-2017 Page 1 of 3

3. Attach a photograph of the shoreline/ buffer proposed to be stabilized. (Include a scale of
some sort- a yard stick, shovel handle, etc.)
4. Location of the property (where work is to be conducted) (�
County: �� I- r� Nearest Town:
Lake/ river/ ocean adjacent to property: !2o—C�,�a�r�
Property size (acres):
Subdivision name or site address (include phase/lot number): Cl �
t.__c -�- �ArA ^L_\ �
Directions to site -please include road names and numbers, landmarks, etc.: �U l..Crl-,e.Q'0jC'!
c n. , r �c�-ZG . F. t t-� ��
Lat`rtuCtln dermal de`grees� 1 Longit�e�Aec►mal degrees}
35,gco (i a --� ,IgB 50
Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): CQ'S', A o
6. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): c, n IF CC- `k CCi T t �rrm
So t P f1
7. Will work be conducted from land? tJ From water? ❑
8. Total amount of impacts below the normal pool lake level / Normal Water Level
Permarler)t impacts (incWding all excavation, backfill, rip rap, retaining walls, etc.) in square feet:
mpacts in square feet:
9. Total amount of impacts above the normal pool lake level / Normal Water Level and 50 feet
land -ward
Permanent'impacts (inclu back fill, excavation, rip rap, retaining walls, etc.) in square feet:
Temporgry,impacts (temporary clearing, construction corridor) in square feet:
10. Please describe the vegetation above the normal pool lake level/ Normal Water Level and 50
��ttI
feet landward to be impacted (number of trees, for instance):
J
11. Signature �f t -
Owner Agent's Signature' (15A NCAC 02H .0502(f)l Date
`Agent's signature is valid only if an authorization letter from the owner is provided.
FORM: SSGP 02-2017 Page 2 of 4

Version 12/22/2016
Lake
(At Full Pond/Normal Water Level)
5Q
Fulf.
Normal.W te'eve
Shoreline - - 7
�.a._
„`a
(9120sc,TT�
Plan View
Cross Section View
Please approximately sketch the following information on this plan (provide dimensions for each
item, such as 10 ft x 100 ft) *:
1. All proposed vegetation clearing
2. Location of rip rap or fill to be placed above the Full Pond/ Normal Water Level elevation
3. Location of rip rap or fill to be placed below the Full Pond/ Normal Water Level elevation
4. Location of any proposed structures such as buildings, retaining walls, docks, etc.
5. Location of any excavation or dredging below the Full Pond/ Normal Water Level elevation
6. Location of construction access corridors

4 �e
r �t ,---
akt
Lake
(At Fats Pondr Normal Wat
z�
c
ti
Side View
LL-
L4 I A,) D (�)v(1) LaV)e- I CUc\
3 ft. below full pond water le -,.,el 4 ft. above full pond water level 2 ft. additional clearing
'if necessary
Existing bank
,nft
Q�o�o
Side Vielw
FORM: SSGP 02-2017 Page 4 of 4

EXAMPLE AGENT AUTHORIZATION FORM
-P1, 'j i
rM
Parcel ID:
Lot No. (if applicable) . K r `� __..- Plan No. lif applicable)
Street Address (if applicable): , �� kC KWA60
Owner Name (print)- '" `"'
property owner's Address (if different than the above)' ! j I Lj 0
L6 al St3j_LgG, l r 754q
owner Signature:
The above registered property owners of the above property, do hereby authorize
11-1
of Pht l'S in I I -� V 13�i ,_ C: 7
Agent Name Agent Company ;`lame (if applicable)
to act on my behalf and take all actions necessary for the application, processing, issuance and
acceptance of this permit, certification or authorization including all standard and special conditions
attached.
t hereby certify that the abow Wormation submitted on this form and application is true and accurate
to the hest of my kno*AsdP.
Authorized Agent Marne / Company:
Aufrized Agent Signature:
mate;

_ f 5 -OTG
LExt
Con
.�
(,rx; sf1 C,5) concre.Are- %,P40tKvq&j

Franklin County, NC
Parcel ID
024118
PIN
2840-05-0795
Owner Name
SHIBLES ANTOINETTE TINA
Owner Mailing Address
LOUISBURG, NC 27549
Detailed Parcel Report Tuesday, October 29, 2019
79 024131
F 194
025737
0 88
201
t
•
024118
��► 90
168 R)3
019739 033285
00 s
1025738
General Information
Approximate Acres
053
Land Value
$106,490.00
Zoning
R 1
LAST SALE
Date
4/30/2019
Al > I�
Franklin County
t` nu T1 t Y
T< x/GIS
215E Nash Street
a L'•+r,r:jJ+i.r,!v!:r.�..ar� ,+rnv.i.rp
Louisburg, NC 27549
Map Reference
Building Value
hle -2 PG 59
$116,5?0 00
Price Book Page
$190,000 00 2176 567
j WARNING: THIS .S NOT A SURVEY.
This map is prepared for the Inventory of real property found wrthlr this jurisdiction, and Is
compiled from recorded deeds, plats, and over pubic records and data Uses of this map
! are hereby notified that the aforememuoned public primary Enforrr:at.on sources should be
consulted for verif.catlon of the information coma ned on this map The County and mapping
company assume no legal responsibility for the information contained on this map.

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