20131036 Ver 1_Stream Call Request_20130925

RECEIVED
SEP 2 5 2013
1)Lb&0 -k3' arolina
DWQ-WA 96
Pat McCrory
NCDENR
Department of Environment and
Division of Water Resources
Thomas A. Reeder
Natural Resources
John E. Skvarla III
Governor Director Secretary
Stream OriginBuffer Applicability Determination
Applicant/Owner's Name (corporation /individual who is legally responsible for the property and its compliance:
Applicant/Owner Address: `1 (9 `u `'VI LL_ mb K a , L Vexr`.
Applicant's phone number: ;5z—& /l —&T701 Fax number:
Applicant's email address:
Consultant/Contact person Name (if applicable):
Consultant address (if applicable):
Consultant's phone number:
Consultant's email address:
Fax number:
Name of Project: 9 0 N HD 1110 PS County: (Anavi to
Nearest Named stream + River Basin (from USGS topographic map):
Nause R;Jer t�etrse KIff- 3a1;; ✓I
Please provide It brief description of this project,(attach site plan if available):
Please attach a map of site location indicating project boundaries using USGS 1 :24,000 topo map and MRCS county soil survey.
Location of project site - please include reference to the county, nearest named town and highway number:
NoN Howeu Road, Ncw Bern, Oc,
Has any DWQ staff visited the site ?�, if yes, please provide DWQ staff name,
visit:
and date of
This form may be submitted via email ([e-mail]). faxed (252- 946 - 9215), mailed or hand- delivered to:
943 Washington Square Mall, Washington, NC 27889. (Note: Submittals of the review packages on Friday after 12:00 pm will
be stamped as received on the next business day).
Please contact Amy Adams at 252- 948 -3917 if you have any questions regarding this form.
North Carolina Division of Water Resources
Internet wwwmcwaterouality.ore
943 Washington Square Mall
Phone: [phone]
One
Washington, NC 27889
FAX [phone]
NorthCarolina
An Equal Opportunity/Affirmative Action Employer
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