20071105 Ver 1_Initial Interest_20070625

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JUN-24-2007 SUN 22:32 TEL:[phone] NAME:DWQ-WETLANDS P. 1

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' INITIAL INTEREST IN PARTICIPATION IN THE EXPRESS PERMITTING PROGRAM
FOR THF. 401 WATER QUALITY CERTIFICATION,
ISOLATED WETLAND PERMITTING
OR S.TRE~.M ORIGIN DETERMINATION PROGRAMS M
February 25, 2004 !~ ___.._._~_..-' "
Version 2 ~ `r~'
Applicant Name:
Applicant Address:
san - ~. Cam. ~ .A~. s~,,r,~, Se~h~stl..~

Applicant's phone number: ~ ! ~ - c~S3~ _ Fax number: ~ 2 ~ `~ ~~
Applican~'s email address:
Consultant Name (if applicable): ~ 2A~~ ~-- ~ C~ ~ -' ~ ~~
Consultant address (if applicable j: ~q O ~~ ~. ~ri V ~_
K~J2~~ ~ ~.C 27 J~
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Consultant's phone number: ~ d3,~,Z-~~~-~ Ftix number: ~7~ ! ~3q
Consultant's email address: N F~SS~I ~'t~~ ~ .d Q,l- 50~~'1.-
Type of action requested under the F.:cpress Review Program (check all that apply):
^ ° 401 Water Quality Certification
^ Isolated ~l%etland Pea-tnit
^ Riparian Buffer Approval
Stream Origin Determination
_ 3__ ~,` `~l. Determinations Requested

Name of Project: ~ 3~._~.~ ~~'" _~~ -_ DO t P- ,-' (' , ~ ; ~~ -~>(1 ~r~4~G~~1 ~ t~~=}~~
_ - _-. 1, ~_.____--- t
Property size (acres) r_~~ Q~~-~ __ County: ~~~hs~~
Nearest named stream (from USGS tope map): Sy-~~~`~C 1.~~~ . ._ .
Please provide a brief desct=ihtion of this project (attach site plat if available):
P (~~ ~ oSsz.~ tV11~(QS~S~_ IQ ~ t C~..~~Gzrvv~r~lC-t
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Please attach a map of site location using USGS 1:24,000 map and county soil survey.
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Location of project site -please include reference to the county, nearest name town and highway number:
~'-~1-, ---,-----
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Proposed impacts! F-~ ~ 'Acres of v~etlands
Acres of isolated wetlands
Linear feet of streams
Linear feet of isolated streams
Square feet of protected stream buffers
Has- consultant or applicant attended any DWQ-sponsored training sessions in the past two years? If so,
please list which ones. ©~-
Which other environmental permits will be needed for this project? Please list them below:
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Does this project require approval under the State Environmental Policy Act or National Environmental
Policy Act?
Does this project require approval of a Variance from the NC Environmental Management Commission"
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Are you aware of any local controversy concerning this project? If so, please describe the controversy and any
measures that have been taken with respect to public involvement.
In o
This fora-t must be submitted yea email (c/o [e-mail]) fax [phone]) or hand-delivered
(Parkview Building, 2321 Crabtree Blvd., Raleigh, NC 27604) within the first three (3) working days of the
month for the first three months of the Express Review Program (until January 1, 2004). Application
procedures after that time will be provided at a later date. Applicants who are sel cted to participate in the
Express Review Program will be notified via email or fax with one additional ~orking day. Successful
applicants will then be instructed regarding detailed procedures for full application. Unsuccessful applicants
will be queried to determine if they want to be in the following month's selection process or whether they
want to follow the normal application process.
Please contact John Dorney at 919-733-9646 if you have any questions regarding this forrrt_
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