20110947 Ver 1_Application_20111025

FRED BAIRD BLACKLEY, ASLA
LANDSCAPE ARCHITECT
504 SOUTH DEKALB STREET
SHELBY, NORTH CAROLINA 28150
[phone]
P- Q ? I )y e1 7
Transmittal
To:
Project: C??r`,,.(._.
' -L-?? Project No:
- Date:'
Copies Item Description
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OCT
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For: APPROVAL INFORMATION RECORD REQUEST REVIEW W DENR. TTY
Remarks:
1
Copy To.'
Via: US MAIL AIRBORNE_'? PICK UP UPS

By:
FAX HAND DELIVER OTHER
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20""10047
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 $,ZH-.#O for
impacts of to lake bottom of less than 1 acre and $475.00 for impacts to lake bottom
of greater or equal to 1 acre.
Applications should be sent to:
Division of Water Quality Wetlands Unit
1650 Mail Service Center
Raleigh, NC 27699-1650
I. Applicant Information
2
1. Owner/Applica t Informati,
Name: CL o `
Mailing Address:
Telephone Number:_
E-mail Address:

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OCT 2 5 2011
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t- Fax Number:
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Agent Information (A signed and dated copy of the Agent Authorization letter
must be attached if the Agent has si atory 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

q-Itto
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 i
County: uVvJ ?, Nearest Town:
Subdivision name or site address (include phase/lot number): i I ? cS
Directions to site please include road numbers, landmarks, etc. (T is is not
necessary if an, adeggate vicipityap is ipclu&4c : 11n
2. Describe the eyst?g land use or conqition of the rte at the ti e of
anr?liratinn 4 1.
, t_ , ? 53. Property size (acres):
i5
4. Nearest body of water (stream/river/sound/ocean/lake):LV/f:Ss
5. Desc be %purpose of the proposed work: d?
6. List
ect:
7. Amount of impact (including all excavation, backfill, rip rap, ret fining walls,
etc.) below the normal pool lake level in square feet or acres:
t )?
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 'n
square feet or acres: CL C c -e,4--l -
is r GLc ec 4
b. Please describe vegetation abof fthe norm pool lake level a d 50 feet and-
ward to be impacted, (number of trees for instance): _T SS 1/ Z?
ytA
Applicant/Agent's Signature Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
f^t V ?i ?'
Lake (Full Pond)
Full Pored
Shoreline
Rif-
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FRED B. BLACIU,Y, ASLA
:L.U:; i, fat r,, •.':,] I r_L
4QN SOUTII uE ;^,z B ;)-. IN:!. 704-CA 171
SHEi.A 14C LiU

Please roximatety stretch the following information on this plat
(please provide dimensions for each item, such as 10 fit. x I ft)a
1) All proposed vegetation clearing (provide dimensions) Z. +vQAeA
,) Location of rip rap or rill to be placed above the Full Pond elevation
Location of rip rap or fill to be placed below the Full Pond elevation
"`4) The location of any proposed structures such as buildings, retaining
galls, docks, etc.
•l ) The location of any excavation or edging below the Fall! Fund
elevation. -, F
6) Location of' construction access corrid+orxs, 1°1???, ? ?,?