20120525 Ver 1_Shoreline Stabilization_20120530

20120525
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 276991650
Applicant Information
PaIID
Owner /Applicant h Information
/
Name J-ZQ.- ue_,
Mailing Address /75 /YAA,i AQ A/ f,AIN, 14J
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Telephone Number 9800 -0233 - IV-2 / Fax Number 705 54f- 097S
E -mail Address dN -Vid an tec &4f
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 )
ldi@R —
fName
Company A
ffiliabon
Mailing Address
Weband5 a �ti7ER QUAD
Telephone Number Fax Number
E-mail Address
H 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 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 dm6w-effln( Nearest Town
Subdivision name or site address (include phase/lot number) -fk AW, e, r i AA . Xo f /3
Of
Directions to site please include road numbers landmarks etc (This is not necessary if an adequate
vicinity map is included) m- m117 A"
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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) y9
4 Nearest body of water (stream/nver/ sound /ocean/lake) I Akc..17?!9 l
5 Describe the purpose of the proposed work S'`iare.. Iwa za iya v_ le., S i 1
6 Last the type of equipment to be used to construct the project Outa W16k
7 Amount of impact (including all excavation, backfill, np rap, retaining walls, etc ) below the
normal pool lake level in square feet or acres ISD —*) wo Sg omec Ad-
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
yey �a eA&L .7 ,
8b Please describe vegetation above the normal pool lake level and 50 feet landward to be impacted
(number of trees for instance) IS — to -FroLs a.x t sitm% arw4tk eoiciZ.
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App t/Agent's Signature Date
(Aftnt s signature is valid only if an authorization letter from the applicant is provided )

28
Ppleame fey awn [no s
Man Pmvide done for each I
1) M proposed vets Won cleoft (;
1) Locatm of np rep or fig to be p1m
1) Location of rip rap or fin in be pin
The Wdlon of any proposed Ou
wallih do" oft
NIB =WFMAUM WH UM IP11
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made dimensions)
d above the FUN Pond clo
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11 The mmon of any excavation or ewmaging uumw un run rvuc
elevation.
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