20121056 Ver 1_Shoreline Stabilization_20121115

Agent Authorization getter
To Whom It May Concern:
20 12 10 5 6
This letter is to authorize Bob Martin of Bob's Docks, P.O. Box 304; Glenville, NC 28736,
phone [phone] or cell 828 - 226 -2047, to act as our agent in all matters pertaining to
applications, permits, documents and the construction for the shoreline stabilization project for:
448 Lakeshore Drive (Loth)
Nantahala. Highlands Estate on Lake Nantahala
Topton, NC 28781
Please contact Mr. Martin for any
Owner of Pro
P�Y� E
_
M. Griggs
Donna Griggs
or matters relating to this project.
Dated. Al - q *3 - 1A
Designated Agent:
Bob Martin for B 's Docks
Dated: f D " 0 3
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NOV 1 5 2012
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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 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 $240.00
for impacts to lake bottom of less than 1 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
Raleigh, NC 27699 -1650
?A I. Applicant Information
I ID
Owner /Applicant Information
Name: 'J W NA
Mailing Address: 3 8 Of j�i4 Tt/G�EEJCf SJ
P0NGJ4,&TotJ1_ 1 ysy
Telephone Number: �,,� //� Fax Number: ii/`A
E -mail Address: LA
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:
Compa:
Mailing
Telephone Number: gZ 17 Fax Number: SOR - 773 626p
E -mail Address:
1_3 l°p&b go STo @i Cz,O •Obi
II. Project Information
.I
Attach a vicinity map clearly showing the location of the property with respect to local Iandmarks 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
hand sketch of 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
County: T, V O Nearest Town: ,, Al t
A
Subdivision name or site address (include phase /lot number): 4W &' * "z "W "J AUTz*L
Directions to site please include road numbers, landmarks, etc. (This is not necessary if an adequate
vicinity map is included): _ ¢rd n'1 'Rlo'AW IM N, C. - 0 (A `U URN Y HW Z to 8s " -/-o
UwA 21 T- / y !�? l L& S TU K.N LEFT oy r6
6-F— 964-a &�_7 Pr nOVr-b (_��oAa_F �Ie►✓t;_ 6F A-J::7(_Cr C-+Tt (tt
4.
7.
Describe the existing land use or condition of the site at the time of this application: //maim
Property size (acres):
Nearest body of water (strean-/river /sound /ocean /lake):
Z41<- atJ -#94c
Describe the purpose of the proposed work: 'T 0
- �tf��2�G��✓� �.Gos���l
List the type of equipment to be used to construct the project: kt4f!I—I'
Amount of impact (including all excavation, backfill, rip rap, retaining walls, etc.) below the
normal pool lake level in square feet or acres: 9- 7)_ s 0, AC,6 r 13E�L 13­�
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:
9-76-- saw f 4-at v-,:;-
8.b. Please describe vegetation above the normal pool lake level and 50 feet landward to be impacted
(number of trees for instance): A p&"f- PO-0 t,
M P t s }m (nr ► WY t✓ W/ � Q w- GFrs L:E�/X;*-- T&�gks
o� SL
Applicant /Agent's Signatuilei Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
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Latitude and Longitude of a Point
iTouchMap -com
FADb" a" Ds ktap Maps
Home » Latitude and Longitude of a Point
Page 1 of 1
Maps I Country - State I Places I Google Earth I Cities I Earthquakes I I Am Here I Lat - Long
To find the latitude and longitude of a point Click on the map, Drag the marker, or enter the...
Is Address: 446 Lakeshore Dr. Topton, NC Lot 6 J
Map Center: Get Address - Land Plat Size - Street View - Google Earth 3D - Area Photographs
Try out the Google Earth Plug -in. Google Earth gives you a 3D look of the area around the center of the map,
which is usually your last dick point, and includes latitude, longitude and elevation information.
Latitude and Longitude of a Point
Note: Right dick on a blue marker to remove it. I Show Point from Latitude and Longitude
Clear /Reset All Markers I Center Red Marker Use this if you know the latitude and longitude coordinates of
- -- -. - - - - -.- a point and want to see where on the map the point is.
Use: + for N Lat or E Long - for S Lat or W Long.
Get the Latitude and Longitude of a Point Example: +40.689060 - 74.044636
Note: Your entry should not have any embedded spaces.
When you dick on the map, move the marker or enter an
address the latitude and longitude coordinates of the point
are inserted in the boxes below.
Latitude: 135.170240
Longitude: - 63.656810
Degrees
Minutes
Latitude: 35
10
Longitude: -83
39
Decimal Deg. Latitude: �-
Decimal Deg. Longitude: �.
Example: +34 40 50.12 for 34N 4tY 50.12'
Degrees Minutes Seconds
Seconds -- Latitude: I-
12 8634 Longitude: �-
24.5154 Show Point
® TouchMap.com 2007 -2012
http : / /itouchmap.com/latlong.html
11/01/2012
IY

PkDu rgy*
October 26, 2412
Mark & Donna Griggs
389 Kathleen Street
Ponchatoula, LA 70454
WATER STRATEGY AND SERVICES
Duke Energy Corporation
526 Sm1h Church Street
Charlotte, NC 28202
Maikng Address.
PO Box 1006 / £C12Q
Charlotte, NC 28201-1006
RE: Application for Private Facility F--J Excavation Shoreline Stabilization ED Miscellaneous
Nantabala - -
Dear Prospective Lake Use Permit Applicant:
Reservoir Uses
Enclosed you will find the current Duke Energy Lake Services Fee Scheduk which became effective January 1,
2002, the applicable Shoreline Management Program Permit Application(s), the Duke Energy NwAahala Area
(DENA) Shoreline Management Guidelines (SMG) which became effective July 1, 2003, and the DENA Private
Facilities Users Agreement. The purpose of the program is to comply with Federal Energy Regulatory
Commission (FERC) orders and requirements for authorizing facilities constricted inside the project boundary of
Duke's licensed lakes.
The Applicafion(s) will be reviewed after being completed and returned to Duke Energy Lake Services - EC12Q,
PO Box 1006, Charlotte, NC 28201 -1006. PLEASE USE YOUR MAILING ADDRESS ON THE
APPLICATION(S) and type or print information for legibility. No activity is allowed inside the project boundary
until you receive written authorization from our office, and no approval will be given to anyone other than the
property owner. A check made payable (o Duke Enerev for the appropriate filing fee (see enclosed fee
schedule) must accompany the following before the review process will be initiated. A completed DPNA
Users Agreement must be signed by the adjacent property owner and included with each application. An
application is not considered complete without the signed Users Agreement.
PIER/DOCKISTA BILIZATION:
1. The completed application(s) (for pier structures include both proposed and existing facilities). Include the
Duke Energy permit number if one has been previously assigned to any existing structure on the
property.
2. The form describing directions by road (including section and lot number if applicable), and the area of the
planned construction/activity marked on the grid map (if enclosed).
3. Copy of a registered survey of the property, showing proposal's location From your property into the project
boundary.
4. Copy of county building permit, if one is required by the county. (Applicable to pier structures only except for
Burke County which requires a building/shoreline protection permit for stabilization.)
5. Other information, including mitigation plans or cultural resource consultation documentation, if applicable.
6. Latitude and Longitude coordinates must be supplied in order to process the application. Coordinates can he
obtained from www.orbisinc.com /snto /.
FOR NORTH CAROLINA STABILIZATION:
t. TWO (2) COPIES of the NC Division of Water Quality (DWQ) Pre- Construction Notification Application
(can be found on internet site. hap:11h2o.enr.state.ne ur1newe11ands4ake.hrml) and the DWQ application fee
must be provided to the NC Division of Water Quality, Attention: Cyndi Karoly. 401 Permitting Unit, 1650
Mail Service Center, Raleigh, NC 27699 -1650.
Thank you for your cooperation in working with us through the Private Facilities Pennitting Program. Should you
have any questions or need further assistance, please call the Lake Representative for the Nantahala Area (928-
369. 4513), or you may call Toll Free 1- 800 - 443 -5193.
Sincerely,
Lake Services
www. duke - energy. com

DUKE ENERGY LAKE SERVICES
EC12 -Q
P O BOX 1006
CHARLOTTE, NC 28201 -1006
704- 382 -1567 or TOLL FREE 1- 800 -443 -5193
APPLICATION FOR PERMIT TO STABILIZE THE SHORELINE IN NORTH CAROLINA
Please type or print and fill in all blanks. If information is not applicable, so indicate by placing N/A in blank. PLEASE
SUBMIT APPLICATION AND APPROPRIATE DUKE ENERGY FILING FEE, PAYABLE TO DUKE ENERGY,
TO ABOVE ADDRESS.
Applicant
A. Name =�
B. W i; Address S'•
C. Telephone:�Is- �rSG' 3 �% CM i ��- y s� -�7 1 Cep
H. Location of Proposed Project
A. Lake _ -&
B. Street Address `I -I La
C. County tan mn g
D. City , town c tnmunity or landmark
E. Section - n Lot # _o_ ubdivision ;
F. D' tons to 7P�Qp�e�rty by road J= - kd.
lr raJal -ja-A & 1-( n r A Fa (&h,,4D 6,0 t
G. Latitude *A longitude for the project site j,S - / -2 O --1'{- a - *90. 1-3 n 91V
H. Please submit a map showing the coordinates or a detailed map (USGS quad map, city map, ebt:.) showing the
exact location of the project site. (NOTE: Latitude/ Iongitude coordinates can be found on internet site,
www.mapsoutts.com. Directions: Don't register, click "Maps", enter address, draw map, select "Map Clicking
Will... ", select "LatlL.ong", click map)
III. Description of Project
A. Length of wall -�
B. Material S r _%iL
C. Distance from propefty line /shoreline -
IV. Intended Use of Proj/e�t Area
A. Private +t M
B. Commercial
V. AppfiaM %tatere _ Date
PLEASE NOTE THE FOLLOWING:
• 2 COPIES OF THE "DUKE ENERGY APPLICATION FOR PERMIT TO STABILIZE THE SHORELINE IN NORTH
CAROLINA ", PHOTOGRAPHS OF THE SHORELINE TO BE STABILIZED, AND FIVE (5) COPIES OF THE
COMPLETED "NC DIVISION OF WATER QUALITY PRE - CONSTRUCTION NOTIFICATION APPLICATION"
MUST BE SUBMITTED WITH THE DIVISION OF WATER QUALITY APPLICATION FEE TO:
NC DIVISION OF WATER QUALITY
ti ATTENTION. CYNDIIL9ROLY
PARKVIEW BLDG., 2321 CRABTREE BLVD.
RALF,IGH, NC 27604
919- 733 -1786
Y.tLAKEMGMTVackage InformatiorANC Shoreline Stabilization Application. doe

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DUKE ENERGY DIRECTIONS BY ROAD FORM
Lake (Ise Permit Applicants and Cantrattors: l aSE of toeittrtg 1lUe proposed protect sere can have a bsg
intput on permit processing time. Please complete thj3 fin and return a along with your mnpiveA prnnN
application to:
DUKE ENERGY
C!o LAKE SERVICES - EC 12 Q
PO Box 1006
CH.ARI..OZTE, NC 28201 -1006
1 -801 - 443.5193 or Option 5
0
Applicant'$ Name: O'" X92
Sot el Ad&m tat take):
Um
Subdivision Nam OVA a�4
Ptopotty 5001100: t,ot *7,
cif M &A,
lad . 3 �' . /'?Q -240 1vinma S3 .&5619 lo
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DirvGd*m (tom m4or road or highway):
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(49 * ,� ✓)I /le-5) C.�v►�� yr2-! s� G Nah�� iia ca �1,g� �c��s - /Y��t/(�_
c 4OReAc,'vnS Da-b- (Code- L/a�) /brow
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*NOW rum mm ace hack ar"ds fm it' , to draw as a mar t■ my dbL
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4

*duke WATER STRATEGY AND SERVICES
p0m I WEnergy. Duke Energy Corporation
526 South Church Street
Charlotte, NC 28202
DUKE ENERGY NANTAHALA AREA (DENA) PRIVATE FACIMWss:
ox 6 / EC120
"USER AGREEMENT" LETTER Charlotte, NC 28201 -1006
(You may use this letter and fill in the requested information. Please Print)
Date // Z -/ Z
TO: Duke Energy
c/o Lake Services- EC 12Q
P. O. Box 1006
Charlotte, NC 28201 -1006
RE: (Lake Name) IVIf�,f -4#
(Street Address) 77 a
(Subdivision / Lot #) AyA,%AJj,0* ,416,40.5 4—,l—
(Applicant's full name) hd/dm+ 6ky"y C hereby agrees to comply with all requirements
and conditions set forth by Duke Energy's Lake Services' office, or any federal, state or local agencies
pertaining to our Private Facilities application to construct a sryia - se&MK.L-
on Lake/f/ in addition, Ave have read and agree to comply with Duke Energy's Shoreline
Management Guidelines (SMG) and understand that written authorization must be obtained from Duke's
Lake Services' office prior to beginning any activity /construction within the Project boundary. The
construction will be completed as described in the approved private facilities program application and within
twelve (12) months from the date of approval by Lake Services. Failure to complete construction within the
build -out period will require the applicant to file a new application within the then - current guidelines. The
filing will include any applicable fees and security deposits.
Uwe attest to be the owner or lease holder of the tract of land immediately adjoining the Project boundan�
where the proposed facility is to be constructed.
Uwe understand the physical location on my /our lot in relation to the common property line with Duke Energy.
the FERC Project boundary, and any deeded flood easements or required building setbacks.
i /we understand that this lake was constructed as a working hydropower reservoir for the primarily purpose of
producing cost- effective electric energy and that this remains as the Lake's primary purpose. Uwe understand
that the lake and its associated hydropower station are operated by DENA under the terms of a license issued
by the Federal Energy RegulatoryCommission (FERC) and that there will be no change in hydro project
operations as a result of the construction and/or use of any facilities that l /we may be allowed to place within
the FERC Project boundary or ou -DENA -owned property.
1 /we understand that lake levels will rise and fall over time in response to weather events and hydro project
operations.
IN' NA PRIVATE FACILITIES USERS AGREEMENT
Final Rem. 10.11-03
Page l of 5
www. duke - energy. cnm

Uwe acknowledge that DENA provides no guarantee of any specific quantities (except those identified in the
Low Inflow or Hydro Project Maintenance and Emergency Protocols) or quality of water in the lake.
Ilwe acknowledge that DENA does not guarantee that an approved facility will always have sufficient water
depth to be accessible by boat or for other water depth related recreation activities.
Uwe understand that the structures to be installed are my /our property and I /we therefore agree to be fully
responsible for the permitted reservoir use including maintaining structures in good repair. If the facility is
deemed unsafe by a Lake Services Representative, Uwe agree to repair or remove the facility at my /our own
expense and within the specified timeframe. This responsibility is considered to transfer automatically along
with ownership and leases of the adjoining tract.
Uwe understand that as an owner or lease holder of property directly adjacent to DENA's Project boundary
Uwe enjoy the same rights and privileges for general recreational use and enjoyment of the Project lands and
waters as are afforded the general public. Uwe understand that as an adjoining property owner Uwe may, with
proper written approval, be considered for expanded privileges as specified in the DENA SMG.
Uwe understand that certain activities specified in the SMG are prohibited because of the DENA lakes small
size, environmental concerns, boating capacity limitations, safety considerations and other reasons.
Uwe understand that ownershiplinterest in a Common Use Facility eliminates the option for me /us to also have
a separate facility on any other lot within the affected subdivision that Uwe own or lease.
I/we understand that Lake Services' approval of the requested reservoir use in no way constitutes assignment
of an interest in real property (i.e. land rights). The approval is granted and maintained solely at Duke's
discretion. Uwe also understand that the permitted use may be revoked at any time by Duke Energy or its
successors for any reason whatsoever. If the approval is revoked, Uwe agree to remove the facility at my /our
own expense within the specified timeframe set by Lake Services.
Uwe specifically waive any claim for consequential damages arising out of or relating to this application,
Duke's approval or denial of it, or Duke's subsequent revocation of approval, and Uwe specifically understand
and acknowledge that, because Duke Energy can revoke the permitted use at any time, I /we are not entitled to
reliance damages.
I /we understand that there will be no change in hydra project operations as a result of construction and/or
utilization of the permitted proposed structures.
Uwe understand that the proposed structure will be used only for the purposes described in the information
submitted to Lake Services and other appropriate governing bodies for approval.
Uwe understand that this lake is open for use by the general public and that maintaining safe and lawful public
use is one of the primary lake management objectives of DENA.
Uwe understand that the use for which we are applying is a private use and it should not interfere with the
general public's safe and lawful use of the lake.
Uwe understand lake use permit holders have the authority to prevent others from trespassing on the structures
they have built. I/we also understand that Uwe, however, do not have any authority to impede anyone from
DP NA PRWA'[E FACILMI S USERS AGREEMENT
Page 2 of 5
Final Rev 1011V03
4

pursuit of the lawful public recreation enjoyment of FERC Project lands and waters. Except as specified
otherwise in the SMG or other DENA documents (e.g. Public Safety Plans), anyone may fish around/under
structures built by others, may walk/wade/fish within the FERC Project boundary or any DENA -owned
peripheral strip, boat in the lake's waters, etc. without having to get anyone's permission to do so. Boaters may
not block ingress/egress to piers/docks.
Uwe understand that every reasonable effort must be made to minimize any adverse impact on fish, wildlife,
and other natural resources.
Uwe understand that trees and vegetation growing within the Project boundary play an important role in the
overall environmental condition of the lake. The ecological benefit the vegetation has on the fish and wildlife
habitat supports a sound and healthy lake environment. Uwe also understand that unauthorized removal of
shoreline vegetation (i.e. button bushes, willows, cattails, etc.) and/or disturbance of the shoreline buffer may
result in suspension or denial of lake use permitting requests and require me/us to re- establish the vegetation, if
the disturbance is found to be in violation of the state or county watershed buffer regulations or Duke Energy
Nantahala Area Vegetation Management Requirements.
I /we agree to notify Lake Services when construction is completed. During the construction period, the
weather -proof "Duke Energy Approved Lake Use Activity" sign (to be provided by Lake Services) must be
posted at the job site, visible from the water's edge.
Uwe agree to notify Lake Services if the property is sold and provide the name and address of the new owner.
The new owner has 180 days following the date of closing on the property purchase to sign this agreement and
its conditions.
Uwe agree to fully disclose all information regarding the approved private facility to any prospective
buyer /leaseholder of the property and any new owner /leaseholder. Uwe agree that Duke Energy Lake Services
will be notified immediately of any sale /transfer of the property and the transfer of the permit to the new
owner /leaseholder.
Uwe agree that Duke Energy may enter into agreements with third parties permitting use of the Project property
that promotes the overall recreational purposes of the Project.
Uwe agree that this agreement confers no right to construct or maintain public and private beaches, marinas or
campgrounds.
Uwe agree that the adjacent Duke Energy Project property shall be used exclusively for non - commercial
recreational purposes.
Uwe agree not to rent, lease or otherwise allow third parties (except for temporary use by guests, family
members, and renters of the residential property) to use any structures permitted to me /us by DENA.
I /we agree not to allow any use of the adjacent property and will exercise due care and diligence to prevent all
other persons that are affiliated with my /our property (including invitees, family members, guests, etc.) to
violate an applicable federal, state or local law or regulation. Examples include but are not limited to nudity,
illegal discharge of firearms or fireworks, controlled substance abuse, public drunkenness, public urination or
defecation, or other activities determined to be a nuisance by law enforcement officials.
DP NA PRNATE FACILMES USERS AGREEMENT Final Rev 10/13!03
Page 3 of 5
7

Uwe agree to exercise all care and due diligence to preserve and maintain the character of the DENA's adjacent
property. I/we agree to comply with the DENA Vegetation Management Requirements. Uwe agree further to
not allow sewage, including discharge from septic tanks (or similar facilities) or boat holding tanks, garbage,
trash, or other waste material to be discharged or dumped into the reservoir, tributaries or adjacent property.
Uwe understand that as an adjoining property owner Uwe can make no'thange in land form of land within the
FERC Project boundary or land owned by DENA, such as grading, excavation or filling without prior written
approval by Lake Services.
Uwe agree that only floating piers/docks (unless otherwise authorized by DENA in writing) will be placed on
the Project property and that no piers /docks or structures will be built on Project property without prior written
authorization by DENA.
Uwe agree for myself/ourselves, members of my /our family, guests and invitees that I/we assume all risks of
personal injury or property damage incident to my /our occupancy and use of the premises; including but not
limited to any personal injury or property damage which may be sustained as a result of flood waters or in
connection with the rise and fall of water in the reservoir as a result of floods or of the operation of Duke
Energy's hydro electric facilities. Uwe as the adjoining property owner further agree that Uwe will indemnify,
protect, defend, and save harmless Duke Energy from any and all loss, cost, claims damages, expenses,
judgments and causes of action for all injuries and damages sustained by the members of my /our family,
guests, and invitees arising or claimed to have arisen in connection with their occupancy or use of the DENA -
permitted facility(s).
Uwe agree to comply with all FERC orders (as modified or interpreted by FERC), with all other applicable
FERC Rules and Regulations imposed by Duke Energy, and with all rules or regulations imposed on Duke
Energy by any governmental agency.
Uwe understand this user's agreement does not have an expiration date and is transferable to the next property
owner provided the new owner signs a new agreement within 180 days following the date of closing on the
property purchase.
Uwe have included a check for the applicable filing fees and security deposits and copies of all other necessary
permits.
Uwe acknowledge that. DENA has the right to charge reasonable user's fees for private use of its property and
that failure to pay any applicable user's fees in a timely manner can result in the suspension or cancellation of
any previously approved lake use permit.
Uwe agree to maintain any prescribed mitigation activities that are required in order to gain approval for
facility construction, as long as the facility exists.
Uwe agree that camping is only allowed in designated areas.
Uwe recognize that Uwe have the continuing responsibility to ensure that the constructed structures are
maintained in good repair, including, but not limited to maintenance of the dock and boat slips, and proper
erosion control within the permit area and along the shoreline, and agree to take all reasonable steps necessary
to meet this responsibility. Uwe agree to maintain all structures within the Project boundary on DENA -owned
property in a sound condition and in a neat appearance and pay all costs for said maintenance.
DP NA PRIVATE FACILITIES USERS AGREEMENT 5 Final Rev. 10/13/03
Page 4 of 5

llwe agree that if any action is taken by Duke Energy to enforce any provision, covenant or agreement
contained in this user agreement or DENA SMG or if Duke Energy is required to retain an attorney to enforce
any provision, covenant or agreement contained in this user agreement or SMG (including, without limitation,
the payment of fees due hereunder or the removal of an encroachment constructed in violation of this user
agreement or SMG), then Duke Energy shall be entitled to recover all of its reasonable costs associated with
such an action, including but not limited to, attorneys' fees and court costs incurred in such action and/or
enforcement; provided, however, that the undersigned shall be entitled to recover all of its reasonable costs
associated with such an action, including but not limited to, attorneys' fees and court coats incurred in such
action and/or enforcement if judged to not be in violation of any provision of the User Agreement or SMG.
[/we agree that L /we have read and will abide by the DENA SMG published under separate cover.
Uwe understand that Lake Services representatives may issue Stop Work Directives for any violations of the
SMG or engagement in prohibited acts or activities on DENA property as specifically identified in the SMG.
Uwe understand that persons found to be in violation will be subject to DENA sanctions which can include: 1)
restoration of the impacted area at the person's expense; 2) loss of consideration of any future lake use
permitting activities for up to five years for improper vegetation removal or until vegetation is satisfactorily re-
established (even if there is a change in property ownership); 3) revocation of a previously issued permit and
loss of consideration of any future lake use permitting activities and/or reinstatement of the revoked permit; 4)
increases in fees; S) modification or removal of non - complying structures; and /or 6) further legal action being
taken by DENA.
Sincerely,
(Applicant's Name)
'11 Y9 OXgkY s &t-e �r-
Lake Street Address
_iag�211. /VC_ 6�gnl
City /State /Zip Code
Lake Phone Number
(Designated Duke Energy Agent)
DP NA PRIVATE PACILR ES USERS AGREEMEM
Page 5 of 5
u-, if. 4
Applicant's Si re
38R h/,qA S* _
Home Street Address
?cn\cIa._4o,,_Lcr D o
City /State /Zip Code
9,fJ__,3 L
Home Phone Number
Date: /l " "q — /'a
Date:
Final Rev. M17103
0