20120854 Ver 1_Application_20120913

220854
ApPULwWw show be Set W.
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16" man SUAW Caft
JWeIgh, NC 27699 -1650 SPAI
QwnedApplicmt lnf Sian
Nate: c Eu C CO. WC..
Mailing Adder: �O �O
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Telephone Number. 35� (a.-Sq 32bk Fax N'=ber: �I i 3 2 65
E mafl Ad4im: C bar _k le ac v - bv' i•.l 6 co
Z. Agent InfoarnWon (R sip and +dated OM of Agent Aaft&ariott tae attached
if tto Agent hw aiSnaory orit�, f0jr d= OWj=r /fit.)
Name:
Company Affiliation.
Mailitm Address:
Telephone Number: Fax Number
E -mail Address: we�aq(i>L
U. Project Idor madan
Attach a vicinity map clearly siz� the lt>zon of the paperty with rest to local landmarks such
a$ towns, ri vers, and road. Also provide a dull sfe plan Showing l bauedaties and
development pyres In to 00n to suttTOUQ W$ POPa'tits. You may use the diagram below to make a
hazed sketch of your Pmoject, Also, no the example below for gaidartoe, Both the vicinity map nnei citp
pian OR& include a scale and north arrow. The Biters of all buildings, kVervious surfaces, or other
facilities must be inchtded.

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1. Location
County: _6-A. etL Nearest Town-
Subdivision matte or site address (include pharr Aot.nutnttct): T 777c- *tyeO
Directions to site please i l le 0� 0'rs, landmarks, etc. (This is not necessaxp if an adequate
vicinity map is.mct : S� Alove7AI %' 1- S KYL4-t�
T� • TY/ L f d S of L , s 6A -J L�
�. Describe the existing land use orcondition of the site at the time of this application. avlz -,614) 1-07
I Property size (acret): D 44ef5
4. dearest burly of water (str+e Vrivet°lsoundloceantlake):
5. Describe the purpose pf the proposed work: 4,6 5741Le- !'f /p�_ �'�/�/
607# �2� =VE�7 E6—P-7# �l off[ O
Vii. List the type of equipment to be used to construct the project: � Skrb S7tMe C.oW69..
7. Amount of impact (including all excavation, backfill, rip rap, retaining walls, etc.) below the
normal pool lake level in square feet or sores: Z931 X 4 "= 77Z Sr-
8.a. Amount of impact (including all clearing, back fill, excavation, rip rap, retaining, walls, etc.)
above the normal ]lake level uAd 50 feet land -ward in square feet or acres:
/ O
8.b. Picasc dC$Cdbe W904tion a ft nortttal pool lake level and 50 .feet landward to bo impacwd
(number of trees.for instance): „&o&�M L- r 1fl-y /fjey—
c.�ss 7l/iv s Ai
ApMrtantTAgent "s Signature Date / •
(Agenrs signarure is valid only Iran authorization letter from the applicant is provided.)

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Applmfloms abould be tsmt to;
1. + w=/Appiicant Inforrttadon
Nst"W.-
Maiiing Address:
Telepbtmt NTumber: fax Numbs.
E -mail Address:
2. Agent Information (A signed and dated +copy of the Agent Au ttaftzarion letter nmst be attached
if the Agent hex story authority for ft ownerfappiicant.)
Tame:
Company Affadon:
Malin$ Address-
Telephone lumber: Fax Number
E--nm+ l Add mss:
LL, Project In6wnx on
Attach a vithft mrap cieady showing the locMion of the propftty with respect to local Wadmarks such
as towns, nvcrs and roa& Also provide a "iW sfte plan showing properrp boundaries and
development glans in repro to ceding properties. You mad► an the diagram below to make at
hand sketch of your pmject. Alm we the example !below for guidance. Both the vicinity map a nd site
plan trust itickide a Wik and north arrow. The fooipcatrts of all Iwiidiags, impervious surfaces, or other
facilities must be incitdrd.

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