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it Is prays W ba a n0gallon bank orbrm fee PMFM PMPSW for
nodgw1on of kv*Qls? If sN ateeshihe a=pbmm lew We ndtlipam bm*
or ir4m fm program.
E3 Yes No
18. Is ibe pn�ect to steel bt enY of NCe twenf3► caas�l counties. ityee, se> 1h
below.
Yes Q No
1h. Is go pmbd located Wdn a NC UM Area of awl!WAM A COMO OEM
Q Yes �(No
2. Project
28. "ame of project:
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3. Owner hd on attt "
3a. I�rne(s) err RacroRted Deed-
L� C. Royer
9b. Dosd aootc mr4 t'e�s i1o.
Boak 2, Page b7. '
3a ReeporndNs Party Qbr WG If
.
Sd. 8tt�ret address
497 $sulb0al Road, San AAWMS lot 83 9,,Iv 'vWr- IMM
9e, Cl�+, state. xJp:
SMkft NC 27974
3f, Ideplione no,:
478.4E&1208
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