20120768 Ver 1_Shoreline Stabilization_20120810

SEP -14 -2005 06:13 FROM:DWQ- WETLANDS 9197336893 TO:918284953050 P:1/5
20120768
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. PIease
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 $200-00 four
impacts of to lake bottom of less than ,1 acre and $475.00 for impacts to lake bottom
of greater or equal to I acre.
Applications should be sent to:
Divisions of Water Quality Wetlands Unit
l 4:
1650 Mail Service Center
Raleigh, NC 27699 -1650
I. Applicant Information
1. Owner /Applicant InformatiocnI
Telephone Number: � 4 Fax Number:
Z. Agent hdormation (A signed and dated copy of the Agent Authorization letter
must be attached if he Agent has signatory authority for the owner /applicant.)
Telephone Number: 314 g�y �- A Fax Number:
E-mail Address: m a r r`n c w „ 2 y- e m ed �
1I. Project Information
Attach a viciui ty map cicarly showing the location of the property with (respect to
local landmarks such as towns, rivers, and goads. Also provide a detailed site
plans showing property boundaries and development plans in relation to
surrounding properties.. You may use the diagram below to-
AUG % 0 2012
DENR - WATER QUALITY
!etlands & SkHmWater Bran
09 -13 -2005 19:47 MARINE CONSTRUCTION CO 8284953040 PAGE1

SEP -14 -2005 06:13 FROM:DWO- WETLANDS 9197336893
T0:918284953050 r:dlo
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 `/ 6410p), � 4
County: "L t� ( dearest 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 inclued):
2. Describe the existing land usq or condition of the site at the - time of this
3. Property size (acres): 1 JT
4. Nearest body of water ( stream/river /soundlocean/lake): �a � � � --1,'�
5. Describe the purpose of the proposed work: 1
6. Li tube type,of equipment to be used to construct the project: .�� �'c[ ��e e
7. Amount of impact (including all excavations, backs//, rip rap, retaining walls,
etc.) below the normal pool lake level in square feet or acres: -Ahavo r Q 966 St'
8. a. Amount of impact (including all clearing, back fill, excavation, rip rap,
retaining walls, etc.) above the nonmol pool lake level and 50 feet land -ward in
square feet or acres; J/ 36 -5F
b. Please describe vegetation above the normal pool la�Ce level and 50 feet land- 1
ward to be impact (n ber of es for instance): �? vo s s k, ,` 4 s n- 41/ Tv e T
� �
f h t_rN S S ava l�� e
7/3111
Applicant/Agent's Signature — � Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
Rq- 17 —PRRc; 19:47 MARTNE CONSTRUCTION CO 8284953040 PAGE2

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