20210561 Ver 1_USACE Permit Cover Sheet_20210312

Corps Submittal Cover Sheet

Please provide the following info:

1. Project Name: _Emergency Project – Replace Bridge No. 136 on SR 1561 (Liberty Hill Road)
2. Name of Property Owner/Applicant: North Carolina Department of Transportation (NCDOT)
3. Name of Consultant/Agent: __N/A ______
*Agent authorization needs to be attached.
4. Related/Previous Action ID number(s):__N/A___________________________________________
5. Site Address: _N/A
6. Subdivision Name: __N/A__________________________________________________________
7. City: ____near Statesville ______________________________________________________
8. County: __Iredell________________________________________________________________
9. Lat: _ 35.88637ON Long: -80.99017OW (Approx. Project Center)
10. Quadrangle Name: ___Central _____________________________________________________
11. Waterways: South Yadkin River (DWR Class: WS-IV)
12. Watershed: _Yadkin-PeeDee (HUC 030401020)________________________________________
13. Requested Action:
_X_ Nationwide Permit # _3_
___ General Permit # _____
___ Jurisdictional Determination Request
___ Pre-Application Request
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The following information will be completed by Corps office:

AID: ______________________________

_____ Prepare File Folder _____ Assign number in ORM _______________ Begin Date

Authorization: ____ Section 10 ____ Section 404

Project Description/ Nature of Activity/ Project Purpose:
________________________________________________________________________________________
Site/Waters Name: ________________________________________________________________________
Keywords: ______________________________________________________________________________