20211700 Ver 1_Site Plan_20211123

Owner/Agent's Signature* Printed Name Date
[15A1 NCC [12N,€35Ci2�€t?
Agent's signature is valid only if an authorization ietter from the owner is provided.
Lake
(At Full Pand/Normal Water Level)
Full Pond/
Normal Water Level
Shore[ine
1 wFAA
t
s
i'
Please approximately sketch the following information on this plan, length of shoreline
(provide dimensions for each item, such as 1 p ff x 100ft) *:
I. All proposed vegetation clearing
2. Location of rip rap or fill to be placed above the Full Pond/ Formal Water Level elevation
I Location of rip rap or fill to be placed below the Full Ponca/ Formal Water Level elevation
4. Location of any proposed structures such as buildings, retaining walls, docks, etc.
5. Location of any excavation or dredging below the Full Pond/ Normal Water Level elevation
b. Location of construction access corridors
FORM: 55GP 10-2013 Page 3 of 3