20130808 Ver 1_Shoreline Stabilization_20130802

20130848
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) copies of this application and supporting
information as well as a non - refundable application fee to the Division of Water Quality of $240.00
for impacts of to lake bottom of less than 1 acre and $570.00 for impacts to lake bottom of greater
or equal to 1 acre.
Applications should be sent to:
Division of Water Quality 401 Oversight/Express Review Permitting D �✓ ►�i a�Lg 1
1650 Mail Service Center !r
Raleigh, NC 27699 -1650 AUG _ `.
2 2013
I. Applicant Information t1l 21 �;✓ NR . r�yAr
do TM t
1. Owner /Applicant Information 4ancn
Name: C"b HeATIAe4z- E,.1
Mailing Address: 3-11 SA CA Me D 2 .
Love s 6uk6 N C 2-7!3q 9
Telephone Number. Fax Number.
E -mail Address: Cµ a,'). P E r M56PJ @ YA 4o o . CoM
2. 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:
Company Affiliation:
Mailing Address:
Telephone Number.
E -mail Address:
11. Project Information
Fax Number.
Attach 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.

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1. ration
County: FRPvJ K LW Nearest Town: LUt s GURG , li (-
Subdivision name or site address (include phase/lot number): L A ke I`zuyt -,w T J77
Directions to site please include road numbers, landmarks, etc. (This is not necessary if an adequate
vicinity map is included):
SLE7 GC 2a , i uPLJ eAsr ow-ro CRel Eof"t f -nA-
'THV2auck SeC_VfZ rI CATE. 4:6LLoIJ CRF_TLO-^rt -Ir- SACA^1Un_z /y' 2.Tii t%Z MILc
o^�
5AGA^10-t c C3?,)
2. Describe the existing land use or condition of the site at the time of this application:
3. Property size (acres): • ss
4. Nearest body of water (stn:am /river /sound/ocean/lake): LAKE R o U t_c
5. Describe the purpose of the proposed work: L u h-n A. SCE W A LL
6. List the type of equipment to be used to construct the project:
7. Amount of impact (including all excavation, backfill, rip rap, retaining walls, etc.) below the
normal pool lake level in square feet or acres: &ACa t t L , Po Ss t 13 LC (z I p RAP,
/ZfrAi,JWL LgALL
8.a. Amount of impact (including all clearing, back fill, excavation, rip rap, retaining walls, etc.)
above the normal pool lake level and 50 feet land -ward in square feet or acres:
SHaZELlntE - AAIR_ -c $o r-aei of LejGTi
8.b. Please describe vegetation above the normal pool lake level and 50 feet landward to be impacted
(number of trees for instance): MD'i &
8/► 12.oJ3
Apptieaat%gent's Signature Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)

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LAV-& 72 D-(A Le�
{phme pNevide Owradons for each gem, such es 10 ft. x 100 It):
1) M proposed veWetlon clearing (provide dimen rs)
A Location of rip rap or fill to be placed above the pug fond elevation
3) Location of riip rap or till to be placed below the Ful Pond elevation
4) The ration of any proposed structum each as bulldinp. teialning
waft, docks. etc.
sj The location of any excavation or driedging below the Fug t�td
elevation.
�) LOCO of Cormfucum Access Corridors.
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Please appraximately sketch the tadowing information on this plan
tae provide Onensions for each gem, suds as 10 R. x 100 R):
1) M proposed vegetation eboring (provide dimensions)
A Location of rip rap or fill to be plaidd above the Full Pond elevation
31 Location of rip rap or fill to be placed below the pull Rand eievafion
41 The location of aW proposed shuchm such as buildings, retaining
wad docks, etc.
3) The location of any excavation or d iedging beloar t1w Full Pond
elevadon.
6) Locate of construction acces corrldom