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Home My WebLink About20120637 Ver 1_Application_201206272®120637 i 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 impacts 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 Pei mitting 11UN �0 V 1650 Mail Service Center Raleigh, NC 27699 1650 2 7 2012 I Applicant Information I Owner /Applicant Information at" nch Name 2n& 4 D mler Mailing Address �D 3� yt/ t �� V y' Telephone Number �l!�' /' i �� Fax Number ��vl' �`� � 5 E mail Address jaw .l 171,14t-f,`" a 01 te/m 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 Ac."O'd ^ F.-y-L Company Affiliation )?uL,4 k & l P 6 Marling Address ! y &x %make_ WJ f e t; ,C, 72,9 7/0 Telephone Number T03 51st 73145 Fax Number E marl Address aa-rv,- f0 r"+ bu, fcle,rs �uw� II Protect Information Attach a vicinity map clearly showing the location of the property with respect to local landmarks such as towns riNers and roads Also provide a detailed site plan showing property boundaties and development plans in relation to surrounding properties You may use the diagram below to make a hand sketch of your protect 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 of other facilities must be included 1 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 z� vicinity map is included) g5 So - ' e N d)l - -7 L-4—,-_4V_ 4 PV VW! ej 01n �f RJ Gee c�J�60 2 3 4 5 8a Describe the existing land use or condition of thb- site�at the time of this application ) r wi.e, 6o.15 4 r t,.cf o� Property size (acres) Nearest body of water (sjream/nker /sound /1 r r Describe the purpose of the pioposed work ;ean / lake) Le Ae A r- . i- kp +,, 5 � i l t.� 4C►o�`e� •� � fil List the type of equipment to be used to construct the project AA, Amount of impact (including all excavation backfill rip rap retaining walls etc ) below the normal pool lake level in square feet or acres 1,20 SG u-sr� beef ��o� no rw� - Amount of impact (including all clearing back fill excavation rip rap retaining walls etc ) above the normal pool /take level and 50 feet land ward in square feet r acres / SJCO S4twa�"c, C� abdc/�� llocr r .0an 8 b Please describe vegetation above the normal pool lake level and 50 feet landward to be impacted (number of trees for instance) -xe re- , S 4'.'e- D./ ^ � 4-w-e- � � -- Ae_ S k,,,-e l �., 3� n ne ed� 40 he- re m _zs-,IZ Applicant /Agent s Signatuie Date (Agents signatuie is valid only if an authoiization letter fioin the applicant is provided ) CL6044 headlands ct. 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