20120546 Ver 1_Application_20120604

20120546
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 five (5) 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 unpacts 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 p fi-Z,
Raleigh, NC 27699 -1650
u
I Applicant Information J/
UIV 4
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1 Owner /Applicant Information weg°^��►s
Name
{AAU,-5 P D0ml
Mailing Address 105 6L&-,,J ASS64 N44
Telephone Number i �� %3Q -/Q& Fax Number
E mail Address _ L but k 1''uaw,,, a. -td coo
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 J a(( —(V, t'1 /NKt
Company Affiliation 4t�A� fv&/ 6U 1t-1D6C-> 01- WN L 1 A)e
Mailing Address U i .35 LA � L.v�2 NL Ze ?y(�
Telephone Number el Z�� 07o2 Fax Number :51-6 C Z5 <151c7
E mail Address 1 y 144 461 Nr H k k a
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II Protect 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 north arrow The footprints of all buildings impervious surfaces or other
facilities must be included

Location
County Nearest Town
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)
� a� i �,,J �° ,`T A WA-1 k -rl-I st4v
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2 Describe the existing land use or condition of the site at the time of this application
3 Property size (acres) 0 1 j
4 Nearest body of water ( stream /nver /sound/ocean/lake) I-k KC 1-0
5 Describe the purpose of the proposed work RIP t .A(? S! a C- L t tJ- fvL
S�iDQf LiN+G SigtL1 tA1 A- iJi7 -% (JA,t.t_ Pe(J- -6LIf f
b List the type of equipment to be used to construct the project VV,)g i - SA CEO
7 Amount of impact (including all excavation backfill np rap retaining walls etc ) below the
normal pool lake level in square feet or acres 'LI O
8 a Amount of impact (including all clearing back fill excavation np rap retaining walls etc )
above the normal pool lake level and 50 feet land ward in square feet or acres
8 b Please describe vegetation above the normal pool lake level and 50 feet landward to be impacted
(number of trees for instance) &ASS
Applicant/Agent s Signature
(Agent s signature is valid only if an
letter from the applicant is provided )

tuthertord CO, NU -- Ynntable Map
Rutherford County, NC
http: / /arci ms.webgi s.neVnc/rutheri ord /pnntableZ .ast
DISCLAIMER: The information contained on this page is NOT to be construed or used as a "legal description ". Map
information is believed to be accurate but accuracy is not guaranteed.
Tax PIN: 217226
GPIN: 0642063859780000
Account No.: 15227930
Owners Namel: RUDMAN CHARLES P
Owners Name2: RUDMAN NANCY L
Addressl: 105 GLEN ABBEY WAY
Address2:
City: GREER
State: SC
Zip: 29650
Property Address: 223 NORTH
SHORE DR
Acres: 0.1 1
Fire Districts:
:: CHIMNEY ROCK
Sheet Index:
Tile: 064206
Townships:
:: CHIMNEY ROCK
Rudman Rip Rap
Parcels
No. of Bldgs: 3
Map /Blk/Lot: 528 4 Apt_nbr.
Deed Bk/Pg: 966/681
25
Deed Date: 8/19/2008
Nbr Land Seg.: 1
Land Value: $300,000
Stamps: 1180.00
Bldg. Value: $110,400
Land Use:
Defr. Value: $0
Township Code: 02
Total Value: $410,400
Exempt pro:
Sale Price: $590,000
Exempt amt: 0
Neighborhood Code: L30B
Flood Plain:
Neighborhood Desc.: RESIDENTIAL St_nbr. 223
LAKE
St_dir.
Property Desc.: RES OFF BOYS
St—name: NORTH
CAMP RD
SHORE
Zoning:
St—suffix: DR
Other Attributes
at point 1043578, 628988
Voter Districts:
:: Name field not found.
Watersheds:
None
http: / /www.webgis.net Anderson & Associates, Inc. http: / /www.andassoc.com