20131247 Ver 1_Shoreline Stabilization_20131202

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 $200.00 for
impacts of to lake bottom of less than 1 acre and $475.00 for impacts to lake bottom
of greater or equal to 1 acre.
Applications should be sent to:
Division of Water Quality Wetlands Unit
1650 Mail Service Center
Raleigh, NC 27699 -1650
I. Applicant Information
II.
1. Owner /Applicant In
Name: Do,
Mailing Address
Telephone Number:
E -mail Address: r
R.
�5�3 )rti 5�l S"') Fax Number:
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: T_, 6ya / ,tee s
Company Affiliation: Co, .s4 Ca..
Mailing Address: - &,- I Q n 4 I
/�J C.
Telephone Number: M-3 Q JN(u Z Fax Number:
E -mail Address: Mar j.. c cam- 1 e- emJa r!� rr,c.t 1. CuM
Project Information
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
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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 Jf // County: I���, Xa el r Nearest Town: ` % eh e ti.
Subdivision name or site address (include phase/lot number): is Cav,
Directions to site please include road numbers, landmarks, etc. (This is not
necessary if an adequate vicinity map is included):
2. Describe the existing land use.or
CJ ^
3. Property size (acres
of the site qt the time of this
4. Nearest body of water ( stream /river/sound/ocean/lake): L
5. Describe the purpose of the proposed work: 1 vrai o �1= ems,,, t c 4,,
,<? I I - . r-i )
6. List the type of equipment to be used to construct the project:
,f iG� U� e e r Fy-Ca VG 4c) e
7. Amount of impact (including all excavation, backfill, rip rap, retaining walls,
etc.) below the normal pool lake level in square feet or acres:
O imr2ci4 S Iuw Y[orfrc, ( Qua I .
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: _Da GO SP
b. Please describe vegetation above the normal pool lake level and 0 feet land-
ward to be impacted (number of trees for instance): a_77 e e s 6 v c S S
Applicant/Agent's Signature Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)

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Owner: WILLIAMS ANN E &
Mailing Address: 5075 CHATEAU AVENUE
Physical Address: 884 DAVIS COVE RD
Parcel I D: 0004542
PIN: 3725042766
Deed Reference: 0558 2068
Alexander County
assumes no legal responibility
for the information
contained on this map.
Acreage:
0
Fire District:
BETHLEHEM FIRE
Structure Value:
$49,550
Land Value:
$183,540
Misc Value:
27
Fair Market Value
$236,469
6
$236,469
Account #:
9330740
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Owner: WILLIAMS ANN E &
Mailing Address: 5075 CHATEAU AVENUE
Physical Address: 884 DAVIS COVE RD
Parcel I D: 0004542
PIN: 3725042766
Deed Reference: 0558 2068
Alexander County
assumes no legal responibility
for the information
contained on this map.
Acreage:
0
Fire District:
BETHLEHEM FIRE
Structure Value:
$49,550
Land Value:
$183,540
Misc Value:
$3,379
Fair Market Value
$236,469
Tax Value:
$236,469
Account #:
9330740
Alexander County
November 26, 201:

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Owner: Owner 1
Mailing Address: Address
Physical Address: Physical Add
Parcel ID: Parcel ID
PIN: PIN
Deed Reference: Deed Page
Alexander County
assumes no legal responibility
for the information
contained on this map.
Acreage:
Acres -
Fire District:
Fire Dist
Structure Value:
Structure Val I
f
Land Value:
r
Land Val
Misc Value:
Misc Val
Fair Market Value
Market Val
Tax Value:
Tax Val
Account #:
Account
Alexander County
November 26, 201:

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