20210910 Ver 1_Pre-Filing Meeting Request_20210506

DWR Pre -Filing Meeting Request Form
ID#*
Regional Office*
Reviewer List*
20210910
Version *
1
Mooresville Regional Office - [phone]
Alan Johnson
Pre -Filing Meeting Request submitted 5/6/2021
Contact Name *
Contact Email Address*
Project Name*
Project Owner*
Project County*
Owner Address:
Is this a transportation project?*
brad rozema
[e-mail]
lake lot shore line repair
brad rozema
Lincoln
Street Address
70 west madison
Address Line 2
City State / Rovince / Region
franklin in
Fbstal / Zip Code Country
46131 United States
r Yes ( No
Type(s) of approval sought from the DWR:
fJ 401 Water Quality Certification - I— 401 Water Quality Certification -
Regular Express
fJ Individual Permit fl Modification
r Shoreline Stabilization
Does this project have an existing project ID#?*
r Yes (' No
Do you know the name of the staff member you would like to request a meeting with?
chad
Please give a brief project description below and include location information. *
this is a repair of a existing shoreline that was established 50 years
ago , the existing rip rap is block and scrap block , we want to repair
and replace with a river stone the project is 00 regatta lane denver
north carolina
By digitally signing below, I certify that I have read and understood that per the Federal Clean Water Act Section
401 Certification Rule the following statements:

• This form completes the requirement of the Pre -Filing Meeting Request in the Clean Water Act Section 401 Certification
Rule.
• I understand by signing this form that I cannot submit my application until 30 calendar days after this pre -filing
meeting request.
• I also understand that DWR is not required to respond or grant the meeting request.
Your project's thirty -day clock started upon receipt of this application. You will receive notification regarding meeting location
and time if a meeting is necessary. You will receive notification when the thirty -day clock has expired, and you can submit an
application.
Signature
-tezeeeeF
Submittal Date 5/6/2021