HomeMy WebLinkAbout20120984 Ver 1_Application_2012102520120984
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The following is an abbreviated application form for those applying fora 401- 111iiter euiilily
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 supporting
for impacts to lake bottom of less titan l 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 Permitting
1650 Mail Service Center p 19/;�k j
Raleigh, NC 27699 -1650 JS e D
I. Applicant Information OCT
2 5 ZO 12
l . Owner /Applicant Information DE DN! - yyA�H
Wetlands 0 ITY
Name: aten aranch
Mailing Address: P. 0 , (3o X 71 �! 3
J®u� "�Nlpnt /V Q2 J 5 I
i
Telephone Number: 81 �7Fax Number:
E -mail Address: 14 W r+ e k4 (p t i e) L t; c k. r r, Cc rn
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:
Company Affiliation:
Mailing Address:
ore ( 1r`C. l)C ye-
6 13 c »C --) e- /3
i F, 1
Telephone Number: /� _s��`GI i rat C, Fax Number:
�
E -mail Address: .o, , c�. `f ? , �" (, �orv'
II. Project Information
Attach a vicinity map clearly showing the location of the property with respect to local landmarks such
as towns, rivers, and roads. Also provide a detailed site plan showing property boundaries and
development plans in relation to surrounding propenics. You may use the diagram below to make a
hand sketch of your project. Also, see the example below for guidance. Both the vicinity snap 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
County: L\ Nearest Town: .s 6'1 t A turn o VI
Subdivision name or site address (include phasellot number): P� n+- (+ c r !Du r
Directions to site please include road numbers, landmarks, etc. (This is not necessary if an adequater
vicinity map is included):
toss Y�r� C D(re/' 41.1<1\ e0cell. t
2. Describe the existing land use or condition of the site at the time of this application:
3. Property size (acres): �'Z ae' re.
4. Nearest body of water (stream /river /sound/ocean/lake): ;, k) c �C
5. Describe the purpose of the proposed work: I n C r c e- s c- ('sir-4 e- r _
cJ l f a r n i e !"
6. List the type of equipment to be used to construct the project: C V C e u e,4 c. r e,c re
7. Amount of impact (including all excavation, backfill, rip rap, retaining walls, etc.) below the
normal pool lake level in square feet or acres: D, 6 U�S6 Ft- n f orc�
-f-6 I n c rc S� �,u c f c r of c k
v clic (r'7F, r
8.a. Amount oi' impact (including all clearing, back fill, excavation, rip rap, retaining walls, etc.)
above the normal pool lake level and 50 feet land -ward in square feet or acres:
8.b. Please describe vegetation above the normal pool lake level and 50 feet landward to be impacted
(number of trees for instance): r, U C "e 4 e_� i o h p r t c 5
I M }� a Gtr pP
Appiicant/Agen
(Agent's signatV
/ Z
gnature U Date
valid only if an authorization letter from the applicant is provided.)
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