20110528 Ver 1_401 Application_20110531

CerhCll~tlon to 1n~aCi 1rLrKt; (~eaerss r.~aetgy ~t~uiuavq Wtau.,~savu~ a~.gw~sw.....a...,-...-- --
bottomunder the IJ.S. Army Corps at Fmgi~•s Pmt GP3Q This APB t~n~t be used
for weBand or stream imlaacts. Flange provide seeds (7} of t6~ motion surd sapparting
irdonmadon ag wen sag a nau-refundable application fee to the Dlvisioaa of water Quality of X4.+00
for imposts of to lake bottom of less them 1 acre aml $570A0 f~ ima~pacts to lake bottom of greater
or equal to 1 acre.
Applicatiosss should be slat to:
Division of water Quality 4oi oversightlLxpresa Review p~
iss4 l~dail S~•vice C~
Raleigby NC 27.1660
z Apnt Information
1. QwnerlApplic~mt Information
Name:
i ,r
~~ ~~
2Q110528
~~~--~-oe-~~~
MAYI 3 1 211
- - .--
Mailing Address: ~7 3 ! ( J ~ ~,Y,.sn v, ~1 ~ ~ 1,
~c~,tn. ~, G.. C' . a ~Sa 3
Telephone Number: ~:~ ~~- '~l'7 - ~h I ~ Fax Nnmber.
E-mail Address: ~/ 1- ~ ~~ ~ ' ~~ ~ c:
2. Agent Information {A signed and dated copy of the Agent Audwrization letter must be attached
if the Agenttths~s signatory autho+rity`for die ownerlapplicant.}
Name: ~ 1~.~ ~'~~ ~ ~`-' ~'~
C,om~pany Affiliation• t..~-~ ~~S vv~-- ~-~-~-~---.
ot~ l e. l~~ ~~ S ~o~ ~ C. ~-~~"7~-
Mailing Address:
Telephone Number. .~~ ".5~ `~' - 43 4-a Fan Number:
E-mail Address: (,~ ~~x C~~ ~ erwba-~-a w+~ t • Cs~ w,
II. Project Iu#o~n
Attach a vicinity ms~- clessrly showing the location of the property with respect do local landmarks such
as towns, rivers, and roads. Also provide a detailed site plan shaaring ~+operty bozmdariss and
development plsms in relation to satr~nding prapearties. You may nsc the diagram below to make a
hand sketch of yoar profit. Also, see the example below for guidance. Bath the vicinity map and site
plan must include a scale and north arrow. The footprints of all buildings, impeavious sutfaoes, or other
facilities mast be included.

County: ~,~-5a~ Nesr~est Town: ~¢.rnbr~ l~- C .
Subdivision name or situ address (inchide phase!!ot number): 1.~-~-1 LE- Cl~.a~v- l~o~~-r'
Direcaions to site please include rna<1 numbers, landmarks, etc. (This is not necessary if an adequate
vicinity map is minded): }-~-w K 5~ r-~Q1r~.. ~ 1-}w-~,1!`l r~sA,r-1-~'- ~-o `'~-}'
~~~ >~ ~~
~. Describe the existing land use or condition of the sift at the Circe of this application:
3. Property size (acres): '~ ~ ~ a~C~
a. Nearest body of water (stteannrrivar/sound/aceanllake): ~~~,~~~.-
5. Describe the purpose of the proposed work: ~s ~
t~o..~.L -~ ~v~-~-~--~ eras ~-~ o-~.. pra ~-A-r`~-ti
M:v;: ~'Xe..awa~6r
5. List the type of equipment to be used to the pmoject: ~ a.-•d ~ k-~-~--`r '~'~'r
7. Amount of impact (including all excavation, backfill, rip rap, rrxainireg walls, etc.) below tl~
normal pool lake level in square feet or acres:
I ZS c~ -}-ot-~-~ S Q ~ o~.~
Zaa c~ of ~~ - ,~ ~6 ~ °f ~e ~~
8.a. Anyount of impact (including all clearing, back fill, excavation, rip rap, retaining walls, etc-)
above the normal pool lake level and SQ f~ land-ward in square f~ or sates:
$.b. Please dcscxiibe vegetation above the normal pool lake level and 50 feet landward to be impacted
(number of tt~ees for instance): ~a s"T~7 ~~~'~ - ~ ~"~~
ApplicandAgcnt's Sigr~aotune Data
(A~ent's sib is valid only if an aeon letter from the applicant is provided.)

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