20130392 Ver 1_401 Application_20130415

20130392
The following is an iated applicatimform for those applying for a 401 Water Quality
Cer.0Ficstivai to Impact FMC (Federal Enwgy Rgplator9 Commimton) reguldedMeshoreor
bottom cadet tiwe U.S. Army Corps of deers Permit GPX This Applim -1 cannot be used
for wedaad or stream impacts. Phwe provide seven (7) copim of this application and supporting
inforiosatioa as vwD as a non- rdmdabk applicallon fee to the Division of Water Quality of $240.40
for impacts of to lake bottom of Iris than 1 un and $570.00 for impacts to lake bottom of greater
or equal to 1 acre.
Applim11 1- should be seat to:
DivWon of Water Q=ft 481
1650 Mail service Center
Raleigh, NC 27699 -1650
$PAID
a
I. Applicant Lif tion �
1. OwnedApplicant luftmation
Name:
MatTmi
@69ObIE
APR 1 5 2013
Telephone Number: S/ - yea `&:W Fax Number:
E-mail Address:
s±
2. Agent Information (A signed hod dated copy of the Agent Auth orization letter must be attached
if the Agent has signntory au&arily for the owuedapplicant.)
4
Name•
Company Affiliation
Mailing Address:
Telephone Number: Fax Number:
E-mail Addrew
IL Project InfOi'matiOD
Attach a vicinity snap 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 gmdance. Both the vicinity map and site
plan must include a scale and north arrow. Tice footprints of all buildings, impervious su rtec m or other
facilities must be included.

1. Location
County: Nearest Town:
Subdivision naive or site address (include phase/lot number): : -14e
Directions to site please include road numbers, landmarks, etc. (This is not nay if an adequate
vicinity map is included):
2. Describe the existing land use or condition of the site at the time of this application:
3
4.
5.
Property size (ate): • ...5- GIC,=
Nearest body of water (sheamftiver/soundloc canllake):
Describe the purpose of the proposed work:
Y
6. List the type of equipment to be used to construct the project 17i'�cl /joe
7. Amount of impact (including all excavation, backftll, rip rap, retaining walls, etc) below the
normal pool lake level in square feet or acres:
8.,& Amount of impact ( mcluding all clearing, back fill, excavation, rip rap, retaining walls, etc.)
above the norms pool lake level and 50 feet land w 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): Al, _ c
_ •• M
(Agents signature is valid only if an won letter from the applicant is provided.)
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