HomeMy WebLinkAbout20110234 Ver 1_401 Application_20110311
Ile following is an a.. • • 1 ose applying for a 401 Water Quality
Certirkation to impact-_ 1 I f tort' Commission) regulated lake shore or
bottom under the U.S. Ar,. dt GP30. This Application cannot be used
for wetland or stream impacts. PWVprovide j ' • ? supporting
seven ('>) copiers of this appl on and
information as well as a non-rdbndable appHeation fee to the Division of Water Quality of $24_ 4.44
for impacts of to lake bottom of legs than 1 acre and $574.00 for impacts to late bottom of greater
or equal to 1 acre.
Applications should be sent to: 2 0 1 1 0 2 3 4
Division of Water Quality 401 Ovemight/Express Review Permitting
1650 Mail Service Center
sleigh, NC 27699-1650
I
1. Applicant Information" wean U°v
1. Owner/Applicant Information
Name: e,
Mailing Address: A],),- A Lr? S'?io reS /fir.
...
- ?rce?cAoro Al L , 2Z/c'S'
Telephone Number: -3 3 K- 91/3 :- 3,( 1/ Fax Number. . A/ /A
E-mail Address: n t {, ,hY, C g/?'-
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:
U. 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 no-th arrow. The footprints of all buildings, i Widous surfaces, or other
facilities must be included.
4 .
1. Location
County: Ice,- S o Nearest Town: ?,? a !, a r??
Subdivision name or site address (include phase/lot number):
Directions to site please include road numbers, landmarks, etc. (This is not necessary if an adequate
vicinity map is included): S7N T-o Q, . i ; 0 &J f? 7 ;- a N
L??4rN AI w /tM ?/ g A 1 /? N ?r&A/ lc l lov •• -_.
A.C
2. Describe the existing land use or condition of the site at the time of this application.
3. Property size (acres): %, o /
4. Nearest body of water (stream/river/sound/ocean/lake):
5. Describe the purpose of the proposed work: Ta S1 61a rk {. /?i6 , Q ,J o ?4
_ Q/-C, //'n1 G .
5. List the type of equipment to be used to construct the project:
7
/ 'I, s' L xc??? to??/,S? Su 'k
Arrlount of impact (including all excavation, backfll, rip rap, retaining walls, etc.) below the Stc??
normal pool lake level in square feet or acres: /=-.c-7"
8.a. 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:
O a i-cxo,
8.b. Plcasc describe vegetation above the normal pool lake level and 50 feet landward to be impacted
(number of trees f o r instance): A I G ?/r_e_To /?cmorx (?/_? ,,
/C?4v<S- .
3-1-11
Applicant/Agent's Signature Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
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