20070050 Ver 1_More Info Received_20070119

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The following is an abbreviated application t'orrn for those applying fora 4U1 Water
Qnality Certification to impact FERC (Federal Energy Regulatory Commission)
regnlated lake shore or bottom under the U.S. Army Corps of I~ngineers Permit
GY3U. 'I'bis Application cannot be used for wetland or strewn 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 ~20U.00 for
impacts of to lake bottom of less than 1 acre and $475.UU for impacts to lake bottom
of greater or equal to 1 acre.
Applications sLouhl be sent to: °-~• -~ - -
Division of Water Quality Wetlands Onit
16.50 Mail SerFice Center •
Raleigh, NC 27b99-1650

I. Applicant Information
1. Ownec•/Applicant Information f
ltiame: 91 i
Mailing r~.ddress: d
~'elephone Number:_~~_J
E-mail Address:_~ ~~~

FILE COPY
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F'ax
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2. ,4gznt lnforma[icn (A signed and dated copy of the Agent Authorization Setter
must ire attached if the Agent has signatu~y authority for the ownerr`::pplicant.)
Name: `?.'.^) ~_..~_~ N 'J _
Company Affiliation: "'- N IJ
Mailing Address:__.___~ ~ 0 _ ~~i'~ a S~ ~ __
Telephone Number: I ~ ~ ~' `~ 5 Fax Number-.
E-mail Address,__A_pt i v n n ~ ~4 ~'!M. C. he ~'
II. Project Information
Attach a vicinity map clearly showing the location of the property with respect to
local landmarks such as u~wns, rivers, and roads. Also provide a dztailed site
plan showing property i~aundarits and development plans in relation to
surrounding properties. 'k'ou may use the diagram below to make a hand sketch of

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Your pril~eCt. Also, see the exarr;ple below for gr:idance. Both the vicinity map and
site plan must include a scale and north arrow. The footprints ~.~f all buildings,
impervious surfaces, or other facilities must be included.
location L
C:ounty:_ a~ `~_~._.~~2 _ Nearest Town: ~ ' ~ ~ ~~ . __
Subdivision name or site addres pttasellut number):_ ~ 5 ait~°5 L o~1, f '~
Ulre%ti0175 to site please include road mzmbers, la~rnar}c5, et:. {This is not ~ I~') It- 13~ ~c~t~
Qeoe . ~ if n adequate vicini map }s inc udwd): ~ ivl e _~ ~' i S ~
_l~Il_~~-1Lsa~1~~ ~ c ~~-- ~iS-Y~'~.~11~.~1'~.~rW~~1~L-11~Q1Q!'.S
Describe the existing land use ar condition of the sate at the tune of this
apply tia Q _ _ .. ~~ 1 ~. °~^'!.~i _- _O _._'~'~ .:,/~!~^~,;~c±~'~-_---~- ~~-
3. FroperC}' size (acres
~1~ .
a. Nearest body of water {streamiriver/sound/ocearrl}ake}:-1-- ~ ~C 1,• ~I ~ ~_~~_,__
5. Describe the purpose oft proposed work: l 0 S~ I' S h ~ t e ~ i ~___
~~.~.~~.~_~~F-~~ r _e r ~S i oL~__~._.-._-______...------------- -
6. list the type of equipment to be used to construct the pruiect;._,~~~~~__~
Amount of impact (including ail excavation, backftll. rip rap, retaining walls,
etc.) b~:low. the normal poo! lake lev }ins care .eel or acres: _.,_1 d. v 3-._.~~---._
8, a. Amount of impact (including ail clearing, back till, excavMtion, rip rap,.
retaining wa}is, etc.} above the norms? poo} }ake }eve! and SC! feet land-ward in
spuare feet or acres: ~ . ~O~
b. Please describe vegetation .above the normal poo} lake level anti SO feet }and-
ward to be impacted (number of trees far instance}:___.__ ~~,___-___ _~
App}leant/Agent's Srgnat~are llate=-- -- --__..~
(Agent's signature is va}}d only i:fan aut).~rnrizatinn letter from tier' appli..ant is prr}vided.j

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Phase approximately sketch tlfye foilawing infarmati~n ort ttris fan
(please ~rvvitle dimensions fot each ikem. such as 1t-'Fi. x 10~! 1°t);
1~,q{I praposecf aegetateon cl~earin~ (prc+vicie dimensians~
?~ I`.acatian of rip rap ar Fill Y~ be placet~ ab®ue the ful[ Fans! elevation
3~ Le~catiart cf rip rap ~r fii~ to b~ placed bylaw ih~ ~~I! IPaand ~le~vatiat~
~p The i~rCatian of artiy~ prcrpose~i strucEvr+es sucF~ a5 buildings, reTaining
wal(S• docks. etc.
~1 The ic~cation of any excauation or dr~ed~incd belQ~v the Fu~~ Pand
elevation.
6j I.c~cation a~F ~onskruction access carriciots.
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