20130170 Ver 1_Application_20130222

20 130 1 TO
The Mowing is an abbredated application form tor-thase applying for a 401 Water Quality►
Cererficsiioa
to impact C-.�F eral Energy- R ork Commission) regulated lake shore or
hottoni aiulerlhit-.5,- A i. W.-.-C oifs -of Engineers Perniit-GM. This Application cannot be used
#or w
sills . Please prnvide five (-4)` copies -of this application and supporting
mfiurn� dog as -e#1 ss refundable application fee to the Dion of Water Quality of $240.00
for p�tC€s t�D
Wit I�ottoim of ks than I acre and $570.00-for impacts to lake bottom of greater or
. `&,PpUcations should be -sent to: .
Mision of hater Quality 401 Overs &&Express Review Permitting ^
1650-- IaH-Servim Center
Raleigh, NC 27699 -1650
FI 2
L Applicant Information 1i y ? ®j�
1. Owner/Applicant Information
Name:
Matilinl
Telephone Number. a l - y � " � 6 � Fax Number
E-mail Address:
2. Agent Information (A signed and 4atBd copy of the Agent Authorization letter must be attached
if the Agent has signatory authority for the ownedapplicant.)
Name:
Company Affiliation: iQ4 Dogwood L�lae
Mailing Address: 1l# Gilead, NCMM OW4W W4
Telephone Number: g I N 9 J ORN e Fax Number:
E-mail Address: k a.1 ch 6 bra U) 94 C, u I i N t (' O M
IL Project Formation
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 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.

1. Locadon
Directions to site please inotade
v ► map is inchdbo:
MW
numbm Immk KIM C• (IU is M MCCS&Y if M Date
Z. Describe the existing lam use cr condition of the site at the time of this won:
3. Property see (acres
4, Neat body of wata
f i
li � /.� _ _ _ A
WO ,.
6. Last the type of egnip�t to be used to oax the project
i
L ' r
7. Amount of mgma (fig all mcamon, baddM rip rap. nt3niug waft, etc.) below do
normal pool Ww level in square fact or acres: X
8.a. Amount of Impact (Mi ch drug all dearing, back fill. mcava" rp tap, training walls, eta)
above the nom pool Ift 1pvd and SO fed landward in square feet ec acres:
&b Please dese be vegetation above the normal pool lalm lov+el and 50 ffft..A landw:ar+d to be impaKtd
(nua ber of trees for mstimm): lad
's sigaatav Date
(Agent's signal ure is valid only if an puthadmilou letter horn the applicant is provided.)
104 Dogwood Lane
Mt tlr7ead. NC 27M
91014WI N4

as 10 IL x M 1W
ummdbmd
&0 Fakwo ebvdkm
In PW PON okvaGm
Ism huldba& a I I

I of 1
Brown's Construction
104 Dogwood Lane
Mt Gilead N. C. 27306
910 -439 -1384
2 -12 -13
This application is for the construction of a treated lumber seawall to be constructed in
front of the present seawall. The present seawall was constructed about 30 years ago
and is in bad shape, and not repairable. The new seawall will be constructed about 2
feet in front of the present seawall. And will have 2 inch stone between the new seawall
and the shoreline. And rip -rafF in front of the new seawall to meet Progress Energy's
specification's. The seawall is to be constructed for Dan M. Shive at 684 Fairway
Shores Rd. Mt Gilead N.C.27306.
Date I- -/1 —13
Butch B. Brown

1 of 1
2 -07 -13
Brown's Construction
104 Dogwood Lane
Mt Gilead N.C. 27306
910 - 439 -1384
I Dan M. Shive give Butch Brown of Brown's Construction my permission
to act as my agent in securing permission, permits and construction to be
done at 684 Fairway Shores Rd.
Dan M. Shive
Date o2- t i -13

WebGIS.net:: QuickSearch :: Montgomery County, North Carolina:: Details
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WebGIS.net
quicksearch Montgomery County, North Carolina
Parcel oft
6584 17 10 7579
N81t1e:
SHOVE, DAN MYIS
AQXPUM
0073670
Aden= —T:
407 HARRIS Ill
Addr -&-3:
MOIBIDE, NC 28112
Hame_ aoabe
694
Roadnarlle:
FAIRWAY SNORES
owe 1,
LOT 42; W2, S/B
Dew 2%
FAIRWAY SHORES
DeWjWolm
563
Deeds
576
OS
Sale Year.
06
Sate Prices:
0
BOBdlap Yetrle,
101043
Laced VW=
118508
Other value:
12182
Total Tar bahm 231700
Year euft
1971
AppraisoU.
01
Aces:
.000
The WebGIS.net logo is a Registered Trademark of Anderson & Associates, Inc
This site Is best viewed in a modem browser that supports web standards
Questions, comments or problems" Co., tatt WebGIS Technical Suppat
The tnfonnatlon Card~ an this site is furnished by
gOvelnment and prNate Industry sources and is
believed to be accurate but aopuracy, is not
• Mapping infonnatlar is a representation
of various data souses and is not a substrate for
hdamatlar that would resua from an aeon-ate land
survey. The Warnlatlol contained hereon does root
replace Imtrimatiar that may be obtained by
consulting the irQamatlon"s ofliclal source. In no
event shag Montgomery County. NC or the
mrwdtants of Montgomery County, NC be ilable for
any damages, dlred or airm ientlal, from the use
Of the Illiormatlal dried an dils sloe.
http:// quicksemh.webgis.net/details.php ?site -nc montgomery_co&id=3668&lid= parcels&... 2/8/2013

WebGIS.net:: QuickSearch :: Montgomery County, North Carolina:: Details
WebGIS.net
quicksearch
Parcel Noe
6584 17 10 7579
Nam
SHIVE, DAN M IES
ACcomrtr
Address is
0073570
Add:
407 HARRIS IN
Address -,W.
MONROE, NC 28112
HoumLpunift
664
Roadnarrm
FAIRWAY SHORES
Desc 1:
LOT 42; M/2, S/B
Dew 2:
FAHIWAY SHORES
Deed_ Wc&
563
Deed_paW
576
SakinomtlC
05
Sdo rear.
06
Sale Prim
0
BaBdhrB Vaiva
101043
Land Valom
118508
Other VWUW
12182
Tofal Taz Vahm 231700
Year Buft
1971
Appraisal:
01
Acres:
.000
The WebGIS.net logo is a Registered Trademark of Anderson & Associates, tnc.
This site Is best viewed in a modem browser that supports web standards
Questions, comments or problems" Contact WebGIS Technical Support
Page 1 of 1
Montgomery County, North Carolina
The h9brmation coned on this sit is hsnished by
govemment and private Industry sources and Is
be4eved to be aaauata but accuracy Is not
guaranbeed. Napping IMarnation Is a representation
of various data sources and Is not a subsbft for
Worrnadon that would r— ' from an aavrate land
survey. The Irdormation cwitabued hereon does not
replace brfonymMo a that may be obtained by
consLdWV the information's official source. In no
event shag Montgomery County. NC or the
Consultants of Montgomery County, NC be battle for
any damages, dbect or corsequentlal, from the use
of the infori madom Contained on thfs slta.
http:// quicksemh .webgis.netldetails.php ?site= nc_mOntgomery_co&id= 3668 &lid=parcels&... 2/8/2013

i
owners Business: N.C. pest Control Licence No. 44"W-
Jeff Allen 4593 NC 24/27 West MIKE WILDER TRACIE RUMMAGE
Vivian Cook ML Gilead, PIC 27306 pRESwW VKE PRESIDENT
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