20121048 Ver 1_Application_20121114

SEP -14 -2005 06:13 FROM:DWQ- WETLANDS 9197335893 TO:918284953050
2012 ~1048
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
GI'30. This Application cannot be used for wetland or stream impacts. Please
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 f r
impacts of to lake bottom of less than I acre and $475.00 for impacts to !ak'�e ttom
of greater or equal to I acre.
Applications should be sent to:
Divisions of Water Quality Wetlands Unit
1650 Mail Service Center
Raleigh, NC 27699 -1650
I. Applicant Information
1. Owner/Applicant
2.
Mailing
kcicpnortc Number:_ Jo y - as' 3- d 9 0 � Fax Number:
E -mail Address:
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NOV 1 4 2012
D NR - U ALITY
Agent bafoxmation (A signed and dated copy of the Agent Authorization letter
must be attached if the Agent has y�ignatory authority for the owner /applicant.)
Name.-Nlar,' �r sue• Co. 1 Tr.., ,�,��
Company Affiliation:
Mailing Address:__jh,r ? Flo r .- i7� _
11J1 C_ -, 9'Ga t
Telephone Number. n k - �•9 r - o Fax Number:
E -mail Address �Ylor i'r• Ca •. 'e f &-s-4 d yq Q:,q; I • CfJ r+..
II. Project Information
Attach a vicinity map clearly showing the location of the property with respect to
local landmatlts such as towns, rivers, and roads. Also provide a detailed site
plan, showing property boundaries and development plans in relation to
surrounding properties, "You may use the diagram below to make a band sketch of
09 -13 -2005 19:47 MARINE CONSTRUCTION CO 8284953040 PAGE2

5EP -14 -2005 06:13 FROM:OW@- WETLANDS 9197336893
TO:918284953050 P:2/5
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.
Location l r
County: e ( Nearest Town:
Subdivision name or site address (include phase/lot number):14N
Directions to site please include road numbers, landmarks, etc. T�s is not
recess ,7 if am adegpate vicinity map is included):_ ���d �l
lTc,�c a Ci e # /O� L
2. Describe the
or condition of the site at the • time of this
I Property size (acres): (S�
4. Nearest body of water ( streamh-iver /sound/ocean/lake): 4a% e_ �,'��,c �v •�
5. Describe the purpose of the proposed work: S a l ' i S �+ o v e << ►•
6. List the type of equipment to be used to construct the project•._Toa loo c_ 1"04 J s4c c, _
7. Amount of impact (including all excavation, backfill, rip rap, retaining walls,
etc.) below the normal pool lake level in square feet or acres: & 3 a S F
8. a. Amount of 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: -D 2( / S
b. Please describe vegetation above the normal pool lake level and SO feet
ward to be rim acted �jnumber o trees for �t/ance : Crra s s
_ VCS i TGT,'av, (�'y�� fh a elryC c1 S ort1'L%1 .
Applicant/Agent's S' ature J ate
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
09 -13 -2005 19:47 MARINE CONSTRUCTION CO 8284953040 PAGE2
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DUICF POWER DIRE, MONS BY ROAD FORM
Late Use Permit Applicants and Contractors: Ease of locating the proposed project site can have a big
impact on permit processing time. Please complete this form and return it along with your completed
permit application to:
DUKE POWER
C/O LAKE MANAGEMENT - EC 12 Q
PO BOX 1006
CILUU,OTTE, NC 28201 -1006
1- 800443 -5193
Applicant's Name: ca rot pct i h e
Street Address (at lake): 1 a Gv 2 e.� S Pd.
Lake Name: 1-7 r' G Lc u if I
Subdivision Name:
Property Section: T I Lot
City:_6im- , (= %I S County: �wLelwe��
State: /V C . Zip:
Telephone: _3 0K- " 3 - 350K
Type of Permit Requested
"Circ[e":
ivate Facili
Commercial Facility
Excavation
Stabilization
Conveyance
Miscellaneous Uses
Directions (from major /road ^or highway):
3af Gvo3v /?� Fc-U3 . 1a e 113 �cl. r 1 3
l- le( evS
r..�' a.. F'� SG, Cur+c� ��� I.J . I �c; o� Q. �-
Descriptive Structure on Property (i.e. brick garage, white fence, mobil home, etc):
Cc Y►C v e� e 0 r. cc, J J o a 14UV J t f Gin DI
*N06= Please use the back of this form if desired to draw us a map to the site.
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