20110747 Ver 1_Application_20110815

20110747
The 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
bottom under the U.S. Army Corps of Engineers Permit GP30. This Application cannot be used
for wetland or stream impacts. Please provide seven (7) 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 of 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:
Division of Water Quality 401 Oversight/Express Review Permitting
1650 Mail Service Center
Raleigh, NC 27699-1650
1. Applicant Information
1. Owner/Applicant Information
Name: .4 1 ?x VJ -_---< f 0 g ,t J e
Mailing Address:
Cl ?G
61
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P l u 1"A V i e- N% 0803
Telephone Number: a Q - 6 Z o? - 6 3 a oa
E-mail Address: c'A 1 e)c a 0%_ d e-f
Fax Number: 21o?- 61,2- jj V 6 3
Q.,vt0ft )Q US.dM1W-C 01 . c_o--l
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: /1Z Z Iq
Company Affiliation:
Mailing Address:
Telephone Number:
E-mail Address:
II. Project Information
Fax Number:
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.
1. Location
County: C (-z I J i.J e- [ L Nearest Town:
Subdivision name or site address (include phase/lot number):
Directions to site please include road numbers, landmarks, etc.
vicinity map is included): Se-e- ? I C i n l'
G- r-, v, F,, Is
&C(0CS J//tC'
is is not necessary if an adequate
??'t a 0
2. Describe the existing land use or condition of the site at the time of this application:
3. Property size (acres): 7 aq e_? r t 5
4. Nearest body of water (stream/river/sound/ocean/lake): L e, I Le 14 t` c. V o r y
5. Describe the purpose of the proposed work: g u I q 71 -0 5% . ??. ? 011
clc .SP ?-Tk?s1 S.
6. List the type of equipment to be used to construct the project: Iuc VJ to y 5 P e ?T V e-r-
7. Amount of impact (including all excavation, backfill, rip rap, retaining walls, etc.) below the
normal pool lake level in square feet or acres:
1116/V,6,7
8.a. Amount of impact (including all clearing, back fill, excavation, rip rap, retaining walls, etc.)
above the normal 11 lake level and 50 feet land-ward in square fee or ac es:
e Jr e- e 5 b c e_ S.
A e-J ui_p
8.b. Please describe vegetation above the normal pool lake level and 50 feet landward to be impacted
LtS
CALDWELL COUNTY Budding Inspections
Department
P.O. Box 2200
Lenoir, NC 28645
828.426.8585
828.757.6864 fax
www.crdldwdkwmtymorg
Building Permit
PERMIT NUMBER: 2011-001085
ISSUEDDATE: 07/05/2011 PROJECT NAME: 495SWest Harbour ViewD r-110705-1
OWNER INFORMATION
NAME/PHONEa'#: ADDRESS: 5 Jacob Rd
Yannotti, Alexander & Denise, 516 P. O. Box
935 8632
Plain View, NY 11803
CONTRACTOR INFORMATION
NAME/PHONE #: ADDRESS:
Yannotti, Alexander & S Jacob Rd
tti, Alexander & P. O. Box
Yffi995 8632 Plain View NY 11803
PROPERTY INFORMATION
ADDRESS: 4955 West Harbour View Dr NCPIN: 2785919738
Granite Falls, NC 28630 CENSUS TRACT #: 313.00
SUBDIVISION NAME: Anchors Landing
LOT NUMBER: 6
PROPERTY SIZE: 1.62 acres/sq.ft.
FLOODZONE:
X: Not in flood plain
A: 100 yr. floodplain
AE: 100 yr. floodplain - elevations available
X500: 500 yr. floodplain
PROJECT DESCRIPTION
740 sq R dock.
TOTAL FEES PAID: $88.80
Caldwell County Building Inspector
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49554-larbor View Dr. West, Granite Falls, NO - Google Maps
Gooole maps Address 4955 Harbor View Dr W
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©2011 Google - Map data ©2011 Google -
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