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Temporary impacts (temporary clearing, construction corridor) in square feet:
N I rt
10. Please describe the vegetation above the normal pool lake level/ Normal Water Level and 50 feet
landward to be impacted (number of trees, for instance):
NbNT-- - t3 �( BRC-Ge
11. Signature r.s/
Owner/Agent's Signature [ 15A NCAC 02H .0502(Q) Date
Agent's signature is valid only if an authorization letter
from the owner is provided.
12. Please approximately sketch the following information on this plan and provide dimensions for
each item:
a. All proposed vegetation clearing
b. Location of rip rap or fill to be placed above the Full Pond/ Normal Water Level elevation
C. Location of rip rap or fill to be placed below the Full Pond/ Normal Water Level elevation
d. Location of any proposed structures such as buildings, retaining walls, docks, etc.
e. Location of any excavation or dredging below the Full Pond/ Normal Water Level elevation
Lake
t-
Full Pond/
Plan View
https://files.nc.govincdeglWater%20QualitylSurface%2OWater...%2OPermits/SSGP%2002-2017%2OShoreline%20FOrm_final.docx 10/24/19, 12:14 PM
Page 3 of 5

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EXAM mv LYE
Plan View
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(At Full Ponta/ Normal Vd(Iter Leal)
s
C
Side ViewCL
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ivagen
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Page 4 of 5

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GIVE
LAKE NORMAN DREDGING INC. AUTHORIZATION TO OBTAIN THE NECESSARY
INFORMATION FOR STABILIZATION AND DREDGED PERMITS.
DATE: