20091249 Ver 1_Shoreline Stabilization_20091120

Q9'1249
Tlie 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
hoitoni under the Li.S. Army Corps of Engineers Permit GP30. This Application cannot be used
i,?i o ?il<3nd 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 I acre.
11>1>lications should be sent to: DM_
I)iN ision of Water Quality 401 Oversight/Express Review Permitting
1650 Mail Service Center
Raleigh, NC 27699-1650 ` V
L4
1. Applicant Information NOV 2.0 2009
DENR - WATER QUALITY
1 . Owner/Applicant Information WETLANDS ANDSTORWATERBRANCH
N;iurc: -- rZo 0 C . C N [?, BY
Mailing Address: I) C., J< Q_ i7n-.tya
H ?Q L_t. I?(, C, 2 8 o zr
?h..?ncNumber: V 6 416 -t 427 Fax Number:
I_:-mail Address:
AL,cni 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:
'`Tailing Address:
I'clephone Number:
E-mail Address:
11. 1'roject Information
Fax Number:
:'attach a vicinity map clearly showing the location of the property with respect to local landmarks such
as tov?'ns, 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
!'ad:, a scale and north arrow. The footprints of all buildings, impervious surfaces, or other
facilities must he included.
,:
: ; L;N Nc)ss Lake Ut Yice
,-k P11,1JCA'1
I'lIF tiE10RELINE /

O'i :APPLICATION: L!0,4. I ZC-?O
%PP1,1C:AN I(S):

?; MAILING ADDRESS: o ? ;BIZ. D I YE
?NEEt-yVtu-6 ISC', 284Z? --
?? SIGNATURE(S):
?I?I)KI?SS U1= I-,:'EKE PROPI:KTY: S_i?ME 1?S hna« I?C ? b ? 2?? ? -
) i"10N NAME: }?C 5?? CL ??arz.?n 5
?__l o BLOCK: 'Z LOT: I CGS
1:1:1 ,N 1 LI .NSF' #: PIT #: I (D 2-n
1 1.L1) 1 0N1: ;t FOR CONTACT: (-70(HOME)(164 5E4 aj-7&- (WORK)
l i > it 1 O1' I C?"[ AT SHORELINE: ?Q ? -
I E :%N U PHONE # OF ENGINEER OR ARCHITECT:
LY n F ?_? 5 p? rz ran d r. 67 C4) o1
N,1) PHONE, # OF CONTRACTOR:
L? 2G- L ?a9 3 I?? Z
t1K0110SLD CONSTRUCTION AND/OR ALTERATION OF SHORELINE:
, E <A I`I AC! IED PLANS:
No APPLICATION CAN BE REVIEWED WITHOUT PLANS MADE INACCORDAIVCE WITH USER'S GUIDE.)
Irng;itwn Pumps
individual irrigation pump permit for a lake front lot "(5200)
,wadi copy of vehicle registration
"Describe pump horsepower and give brand/model number
I'I .i:ASE R-LFEK TO YOUR SHORE IMPROVEMENTS CHECKLIST AND USER'S GUIDE
"I-?BMIT TO FIIE LAKE OFFICE OR PLANNING DEPARTMENT, P.O. BOX 429, KINGS MOUNTAIN, NC 28086
It:aliUtLIiLINEAPPLICA"CION.jsh
I .,), anon
bounty: i' V' L L_ vs. Nearest Town: J N L L EY
Subdivision name or site address (include phase/lot number): ke5TGe F-k2 e,
Direction; to site please include road numbers, landmarks, etc. (This is not necessary if an adequate
"'icinity map is included):
Describe the existing land use or condition of the site at the time of this application:
3. Property size (acres): 0. 6 3 AC_ILE
1. Nearest body of water (stream/river/soun(i/ocean/lake): I r,--_?> LA
De?cribc the purpose of the proposed work: t= x VC- ?a O br.! U 0 F 1 q 1 S AL= 1)
t?. I:ist the type of equipment to be used to construct the project: Ar- tL "oA;-
Antouut of impact (including all excavation, backfill, rip rap, retaining walls, etc.) below the
normal pool take level in square feet or acres: . 6 Sb G 1=
.:I. .Amount of impact (including all clearing, back fill, excavation, rip rap, retaining walls, etc.)
above the normal pool lake level and 50 feet land-ward in square feet or acres:
Pi?a,e describe vegetation above the normal pool lake level and 50 feet landward to be impacted
(number of trees for instance): e)LV C N (7) Pct eLAe. TV_r__6G L'12
ur.-1V-kCDyLO C_ is i 1 ai (S b L..c?r.

1\

Applicant/Agent's Signature Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)