20120827 Ver 1_Application_20120831

2Q 1 2 0 8 2 7
The follawft is zmabbrevided appNeation him fw dwa appLyin for a 401 Water QuW*
Calukaffm to hapad FMC (Feaud Enwa RmgalMm Cometaim) T49MIMM kke sham or
boUam under the U.& Army-Co" ofaWimm Pawk GM?bb ApprkadwamM be and
forwedand Orsh"Ift UMPOCIL newprovMe M-M M copies ef this appficadm and suppoirfing
ieftmum as wen 854 of Walw Qua ftof PAM
Car kMaeftef tolaimbetlum ot legs than 1-acreand-$"Mforr imams tobke bottom of greater
or equal to I acm
Apptkafiew Sh=M be sW to
Di bdm of Water QuaIft 401 OvaMdMJRqwM Revim Per mUmg
im-Maus"VieffCenter
RaIdghp NC 27699.1650
Fq
2.
AppBeant.1aftmadon
OwnedAppllad Ubrandon
Nam:
MaifingAddraw
Telephone Number.
E-mW-Add=L-
ED
IC
@ IN V L5
[AUG 3 1 2:012
DENR W--A'MR- I
'I 1'1— L451-63 �(o Fax x=bw
PUKE, LDLA
A
'Sent-Inforrilation (A qp*d and deed copy of the Agent Au"Amm kner must be at,&Iied
if the Agent has sipawry out for the owner /applicant.)
Nam:
CMqMY Affiliation:
Mailing, Address:
Telephone Number
E-mail Address:
IL Pwject hitamadft
Y— V'A' � f �Bx Number:
Attach a vidWty .trap clearly showing dw location of the.pIpperty with nqna to local landmaft such
as W*MS. Avem and roads. Also provide a duaded Me plan showtqS pmpgdyboundarics, and
development pleas M xClation to surrounding properties. you may use the d*= below to make a
hand sketch of your project. Als% see the example below for guidance. Roth the vicinity map and cite
plan tnw include a Mde and north RFIOW. Mke fOoWiM of ail bufldh*s, imperviotis surfims, or odbea-
facilities must-be inchided.

f . Location
County: _ l' l2 S c�l`I Neamo Town: R 6)(110-W
Subdivision name or site address (inaludle phase/lot number): _%i'i
Directions to site please include mad numbers, landrttarks, etc. t"T!:ix
_ is not reveosa } if 3n a d
equate
vicinity map is included);
lST I�D �m
Describe the existing land use or condition of the site at the time of this applic- .lion:
3. property size (acres):
4. Nearest body of water ( sti +eatn/river /scwnd/occan/Iakc): Liu-)
S. Describe -the purpose of the proposed work: JSX not-I OF =
6. List the type of equipm$nl to be used to constrttci the project: £XQ; Vwc DS I- R
7. Amount of impact (including all excavation, baekfll, rip rap, retaining walls, Ck.) boltiw the
nurnwl pail lake level in square feet or ac=*. 4e SS +f.4A4 f y y
S
ii.a. Amount of impact (including all clearing, back fill, excavation, rip rap, retaining walls, etc.)
above the normal pervl lake level and 50 mt land -ward in square feet or acres:
8.h. PIC'= describe vegetation above the normal pool lake level and 50 fact landward to be impact c d
(number of trees for instance): Rltit. S t CI ti S;Mc;ee $
::.2-7- 2 0
gent's signature - D
signature is valid only if an authorization letter from the.applicant is provided.),

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