20100177 Ver 1_Shoreline Stabilization_20100304

20100177
PAID
The following is an abbreviated application form for those applying for a 401 Water Quality
Certification to impact FERC (Federal Energy Regulatory Commission) regulatedlake shore or
bottom under the U.S. Army Corps of Engineers Permit GP30. 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: 0 ? ? ? a V
1 P
Division of Water Quality 401 Oversight/Express Review Permitting
1650 Mail Service Center MAR 3 2010
Raleigh, NC 27699-1650
DENR - WATERQUA "
1. Applicant Information WETUMS AND MOWER BRANCH
1. Owner/Applicant Information f jCz S ??A S
Name: 1-No
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Mailing Address: 7 r02.
_2 S -3 Lo, K-p- Lam,-C a'F?
Telephone Number: 3Y3 " Y 7?- S Y 7 7 Fax Number: - gq 3 -yy l J ?fJ?S
E-mail Address:
2. Agent 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:
Mailing Address:
Telephone Number: Fax Number:
E-mail Address:
II. 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.
Mar 01 10 05:08p
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Location
County: ?? etr' vrGC, Nearest Town:
Subdivision name or site address (weludc phase/lot number):
p.3
L-OS-e. I?u v c._
,(?P s ?? en's apt
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Directions to site please include road numbers, hutdtnarks, etc. (This is not necessary it an adequate
vicinity inap is included): -Lvl?q e ro -?`rvrk ?(r eySondllfle `{a ?a (.(1rr±_ nri 1Ks
1:40AL 1?ke t -i L &aclc k? . r gk-f nn4v 7-Ir-?01
LIP
2. Describe air- existing land use or condition of the site at the time of this application:
i
3. Pruperty size (acres): (:5 S
4. Nearest booty of water (streauYriver/sottnd/oceattflake): f-M.'`k. LtLre-- _
5, Describe the purpose of the proposed work: ?VlS`I?n _ se& [,J0.
?,U 1 ,/I 1.t? C a c.cict_
6. List the type of equipment to be weed to construct the project: ,_A4:;UIC/- Lcti ??'
7. Amount of impact (including ail excavation, bac:kfill, tip rap, retaining walls, ctc.) below the
oonnaI pool lake level in square feet or acres: / ST Giniff e, /,,.e
m Aran V
11 .
8.a. Amount of impact (including all clearing, back rill, excavation, rip rap, retaining walls, etc.)
above the normal pool lake level and 50 feet land-ward in square feet oi• acres:
bot CL
8.b_ Please describe vegetation above the normal pool kakc li=l and 50 feet limdward to be impacred
(number of trees for instance):. _
iplicant/Agcnt's Signature DAG
( gent's signattue is valid only if an authorization left r from the. applicant is provided.)

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