20110261 Ver 1_401 Application_20110322

Jerry Law Interiors, Inc.
PO Box 814
Bishopville, South Carolina 29010
February 21, 2011
To Whom it May Concern:
Please allow Susan Boblett to act on my behalf on this application. She is representing me
and my company regarding this matter.
If you have any questions please contact her on her cell number 919 727 0024.
Thank you for your assistance.
Regards,
Jerry ' LA?resident
Jerry aw Interiors, Inc.
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Office Use Only:
USACE Action ID No,
(If any particular item is not
1. Applicant Information
Form Version August 2006
_ DWQ No.
to this project, please ei?ter "Not Applicable" or "N/A".)
201 1026 1
Owner/Appl'ic`ant Information
Name: ,.J errV L.caVJ
Mailing Address:____ Po R ?,, y I --?
FIMAR 20111
Telephone Number: 9/ y P 70 - C Fax Number:
E-mail Address: a IA/ a C. r. 0.1;
2. Agent/Consultant Information (A signed and dated copy of the Agent Authorization letter must be
attache_ d if the Ag it has signatory au for theo ei /applicant.)
Name ti 7;?t
Company Affiliation:
Mailing Address: toy] t r.?
Telephone Number:
E-mail Address: J
Fax Number:
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. Iloth the vicinity map and site plan must
include a scale and north arrow. The specific footprints of sill buildings, impervious surfaces, or other
facilities must be included. If possible, the maps and plans should include the appropriate USGS
Topographic Quad Map and NRCS Soil Survey with the property boundaries outlined. Plan drawings,
or other maps may be included at the applicant's discretion, so long as the property is clearly defined.
For administrative and distribution purposes, the USACE req.iires information to be submitted on sheets
no larger than 11 by 17-inch format; however, DWQ may accept paperwork of any size. DWQ prefers
full-size construction drawings rather than a sequential sheet version of the full-size plans. If full-size
plans are reduced to a small scale such that the final version is illegible, the applicant will be informed
that the project has been placed on hold until decipherable maps are provided.
1. Location
.-
County: Cv- i Nearest Ti n: J
Subdivision name (include phase/lot number):
Directions to site (include road numbers/names, landmarks; etc.): 401 V 4 U I =
54rdi h-t a ro• 'Iv F, ,,y'',4 Ayr?. 4o S_ Q ?-?=r-
c3Y? f 4r'h? ` , L- )e sn Sagamug_ TL CerhtY
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Page 2 of 4 CkLxcK WC,9 0 .
2. Describe the existing con itio on the site and general land use in the vicinity of the project at the
time of this application: \)a U-4- L &
8.
3. Property size (acres): , '-/ 3 a.c r-.S
4. Name of nearest named receiving body of water(stream/ri ver/lake): / -- ? ?
5. Describe the purpose of the proposed work:
9C
6. List the type of equipment to be used to construct the proj ect:_ /
7. Type and amount of impact (including all back fill, excavation, riprap, retaining walls, other fill,
etc.) below the normal pool lake level in square feet or acres, and distance from shoreline:
N-0 A?L
a. Type and amount of impact (including all clearing, bacl: fill, excavation, riprap, retaining walls,
other fill, etc.) above the normal pool lake level and 5 foot land-ward in square feet or acres:
eF- i- CXF)( {-f7ti t l a VJ
b. Please describe the vegetation above the normal pool lake level and 50 feet land-ward to be
impacted (number of trees for instance): A b" ,
1Z2'-1Z11
ApplicantlAgen s Si ature Dat6
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
Page 3 of 4

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