20011129 Ver 2_Shoreline Stabilization_20130618

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The following is an abbreviated application form for those applying for a 401 Water Quality
Certification to impact FERC (Federal Energy Regulatory Commission) regulated lake shore or
bottom under the U.S. Army Corps of Engineers Permit GP30. This Application cannot be used
for wetland or stream impacts. Please provide seven (7) cow of this application and suppo
information as well as a non - readable application {ee— to"the Division 'ision of Water Quali ty of
for impacts of to lake bottom of less than 1 acre and $570A0 for impacts to lake bottom of greater
or equal to 1 acre. 'P ER 5 Ess M-XF M $ Lk? -b�TTF
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Applications should be sent to:
Division of Water Quality 401 Oversight/Express Review Permitting
1650 Mail Service Center
Raleigh, NC 27699 -1650
I.
1.
2.
Applicant Information ° M
Owner /Applicant Informatio d, ,,
Name: _, LkN t A L L E M
Mailing Address: I S LA LAKE- LSD Z) !R
Mr, G=LEAb N c 2730(
Telephone Number: Fax Number:
E -mail Address:
JUL 18 2013 1
Agent Information (A signed and dated copy of the Agent Authorization letter must be attached
if the Agent has signatory authority for the owner /applicant.)
Name: ;R OG EF- [A h5 RY
Company Affiliation: —_ M AY R. u R Y F E N G'Z W G Z 14 C.
Mailing Address: Lx s 14 w 4 S 2- sb u-t' l; 4
Telephone Number: 710 4 - 3 22 -1 z Zlo Fax Number. 7y q 4-7 4 - 315 2
E -mail Address: M 1= EN cc . C o M
II. Project Information
Aach 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. Location
County: A 0 N T"GS) M E9 V' Nearest Town: NAT'. GT L eA n
Subdivision name or site address (include phase/lot number): EM [TVAL D S.K% R t S
Directions to site please include road numbers, landmarks, etc. (This is not necessary if an adequate
vicinity map is included): 41; W Y -73 t P uT t� E AT, GTJ- M D Tb W L 0 N 6 W 00-b ,
LET tO LXLLY� iii i E �ZD, -MCN LEFT aN EM&2ALO
SNo 2 Es RD . Tki W LFFT '8N S'ZMkA M Krr, G`N D aF
Rfl DO LET -V,
2. Describe the existing land use or condition of the site at the time of this application:
3. Property size (acres): LQT 2S
4. Nearest body of water (stream /river /sound/ocean/lake): LA* 'E- 'tom L-Le-R Y
S. Describe the purpose of the proposed work: 7-(:!� sTAg -XLX ZE -T-"E
SNP RE." L-7XW t
6. List the type of equipment to be used to construct the project: AATNT EY C=A V A-M
-P L#tc_.u- i P
7. Amount of impact (including all excavation, backfill, rip rap, retaining walls, etc.) below the
normal pool lake level in square feet or acres: FT
8.a. Amount of imps ( mcluding all clearing, back fill, excavation, rip rap, retaining walls, etc.)
alyve then pool l le 50 feet land -ward in square feet or acres.
o x x 8S �=
8.b. Please describe vegetation above the normal pool lake level and SO feet landward to be impacted
(number of trees for instance): T R l= E S T1t flT APE Lc t Q R WILY
t�>4 -xNG a !ANDES WW --Wt -D BY1 E12;c N
M
(Agent's signature is valid only if an authorization letter from the applicant is provided.)

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Fm
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Poti b
Please appranda dely sldah the fo@Dvft iftmullon on Wn plan
ageam PF"I a Malts for ead h bem, such as Id M x IN ft?:
1) All proposed veWegon Ilea rkV (pride diumnsione)
2) Le c 11 m of rip rap or fin to be placed above Ote FM Pond slevOon
3) Location of rip rasp or fin to be planed below the Fu• Pond eleaegon
4) 11w kcallon
doffs. wren smh as bnlldin� ring
6) The location of argr exaasation or "dging below dw Full Pond
elevation.
d) Location of con cdm ace corildom

Montgomery County, NC Print Map Page 1 of 1
Montgomery County, NC
Disclaimer: The information contained on this page is NOT to be construed or used as a "legal description ". Map information is believed to be
accurate but accuracy is not guaranteed.
Parcel Number: 6574 15 73 1965
Name: ALLEN, JUNE
House #: 156
Road Name: SOUTHMONT
Road Type: RD
Address 2: 154 LAKELAND DR
Address 3: MT. GILEAD, NC 27306
Parcels
Deed Book: 190
Deed Page: 909
Lot Number: LOT 25; M /A, S/2
Legal Description: EMERALD SHORES
Sale Year: 78
Total Market Value: 482000
Land Value: 257075
Building Value: 219443
Year Built: 1988
Appraisal: 01
Parcel Address: 156 SOUTHMONT RD
Attributes at point: N: 544005, E: 1677222
Fire Districts
Name: Tillery
Townships
Name: PEE DEE
Proposed Voting Commissioner's Districts
District: 1
Zoning
Voting District Precincts
Zoning: Residential 1
Name: PEE
City:
Watersheds
Class: WS -IV
Name: Lake Tillery
River Basin: Yadkin
hItp; /;www we ig,, Anderson & Associates, Inc. Idtp: / /www.andassoc.cum

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Parcel No: 6574 15 73
Parcel Address: 156 5
Owner: ALLEN, JUNE
154 LAKELAND DR
MT. GILEAD, NC 27306
Lot Number: LOT 25;
Legal Description: EM
Deed Reference: Elk.
Land Area: acres
Year Built: 1988
Land Value. 257075
Building Value: 2194,
Total Market Value:
Sale Year: 78
View Property Card(s)
X74 15 73 1965
MaiiahiP I ink frinht -riirk
Parcels
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