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State of North Carolina
' Wk Department of Environment and Natural Resources
Division of Water Resources
15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
Division of Water Resources FORM SSGP 10 -2013
Shoreline Stabilization Application Form
Four copies of the application (including attachments) and the application fee should be sent to:
Division of Water Resources
401 & Buffer Permitting Unit
1650 Mail Service Center
Raleigh, NC 27699 -1650
I. Applicant Information [15A NCAC 02H 0502(a)]
- S D
PALD
1. Owner Inform7,6ft
Name: ,,(L!71-
Mailing Address: aak'l - �'Ia+..A6bti t�l.
Le . r r'-C' ? k- �
Telephone Number. (9(U- 011 Fax Number:
E -mail Address- S c. 11A+J1[h
2. Agent/ Contact Person Information
A signed and dated copy of the Agent Authorization letter (a form can be downloaded here -
http / /www saw usace armv mil/ Portals /59 /docs /reRulatory /regdocs /Permits /SAMPLE AGENT AUTH
ORIZATION FORM pd f) must be attached if the Agent has signed this application form.
Name:
Company Affiliation:
Mailing Address.
Telephone Number -
E -mail Address.
Person to receive the Certification Approval
II. Project Information [15A NCAC 02H .0502(a) & (b)]
1. Attach a vicinity map (i.e. street map) clearly showing the location of the property with
respect to local landmarks such as towns, rivers, and roads.
2. Provide a detailed site plan showing property boundaries and proposed locations of
vegetation clearing, structures (buildings, retaining walls, docks, impervious surfaces,
FORM SSGP 10 -2013 Page 1 of 4

etc ), rip rap, excavation or dredging below Full Pond/ Normal Water Level elevations,
and construction access corridors. You may use the diagram provided at the end of this
application form.
3. Attach a photograph of the shoreline/ buffer proposed to be stabilized. (Include a scale
of some sort- a yard stick, shovel handle, etc )
4. Location of the property (where work is to be conducted)
County: Nearest Town. _{A +C V o ry
Subdivision name or site address (include phase /lot number):
Directions to site - please include road names and numbers, landmarks, etc
S.IpLr SPrctiC 3-7 A Sl 6e-ocl gt_ Forl�
- I'..Cr— Ce { P 4P 1 a rJ F IfS �rA\14 (fir +yl icy , {�.r►— Le�"r
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc ): Ides %eJe—t,,.
6. Property size (acres)- 55 Ac-rc
7 Lake/ river/ ocean adjacent to property 4 k -k, �x
8. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary). C A/c Icr is -C r"JI� -c
9 Will work be conducted from land? � From water? ❑
10 Total amount of disturbance (including all excavation, backfill, rip rap, retaining walls, etc )
below the normal pool lake level/ Normal Water Level in square feet or acres
01- -c. C.i 13S 6,—e, ! 3 5 S� in
11 Total amount of disturbance (including all clearing, back fill, excavation, rip rap, retaining
walls, etc.) above the normal pool lake level/ Normal Water Level and 50 feet land -ward in
square feet or acres - l3 5 f �, __ i
12. Please describe the vegetation above the normal pool lake level/ Normal Water Level and
50 feet landward to be impacted (number of trees, for instance) r--u ve�c1�„�
Owner /Agent's Signature
(/( c0 Ity
Date
Agent's signature is valid only If an authorization letter from the owner is provided
FORM SSGP 10 -2013
Page 2 of 3

Full Pond /
Normal Water Level
m��..'.
Shoreline
COX .
La ke
(At Full Pond/ Normal Water Level)
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2u
M. .
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'Af�a>'- . l �--i ( L
C'�l po—j CC-,,e
Please approximately sketch the following information on this plan (provide dimensions for each
item, such as 10 ft x 100 ft) *:
1. All proposed vegetation clearing
2. Location of rip rap or fill to be placed above the Full Pond/ Normal Water Level elevation
3. Location of rip rap or fill to be placed below the Full Pond/ Normal 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
6. Location of construction access corridors
FORM: SSGP 10 -2013 Page 3 of 3

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Parcel Report - Catawba County, NIC
Parcel Information
lOwner Information
Parcel ID 373510375191
Name DULA SCOTT D
Parcel Address 5515 37TH ST NE
Name2 DULA JENNIFER S
ICity HICKORY 28601
Address 2214 FLANAGAN PL
LRK REID 21312
Address2
Deed Book/Pa a 3146/0053 Deed Imaoe
Cit LENOIR
Subdivision CRESCENT LAND AND TIMBER COMPA
State /ZI NC 28645 -6092
Lots 95
Block
Last Sale $100,000 on 9/17/2012
Schoollnformat�on
Plat Book/Page 19/207 Plat Imaoe
ISchool District COUNTY
Calculated Acreage 0 55
Elementary School SNOW CREEK
ax Map 0200 00017
Middle School ARNDT
State Road 1661
High School ST STEPHENS
[rownship CLINES
JISchQgl Mao
Tax /Value Information jLxRates(pdj
IlZoning Information
Munlcl al Tax District IlZoning
District COUNTY
Fire District ST STEPHENS jjZonlnq1
R -40
Tax Account Number
Zonin 2
Market Building (s) Value $10,500
Zoning3
Market Land Value $88,600 ­--lzoning
Overia CRC- 0,FPM -0
Market Total Value $99,100
ISmall Area ST STEPHENS /OXFORD
Year Built/Remodeled 1960
Slit Zoning District 1/2 0/0
C rr n T x Bill I
Z nin A en Ph ne N m ers
Miscellaneous
Voter Precinct P29 11FIrm
Panel Date 12/18/2007
e I in rmi for this arcel
Firm Panel # 3710373500K
WaterShed
20 10 Census Tract 010301
WaterShed Split NO 112010
Census Block 1003
P r I Re ort Data Descriptions
A ricultural District
Page 2 of 2
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1 LAKE LOT 94 OS L4 A040 A 3soft� /y�F4 %
x 1 .�� I PIN 3�. '9040
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LAKE LOT 95 1
AREA =053 ACRE .W/ LAKE GOT 96
N52915 IN
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PIN 563431 1 P1N
NOTE
BUILDING SETBACK LINES ARE
30 FT FROM ROAD RIGHT OF WAY LIMIT
30 FT FROM LAKE BOUNDARY AND
IS FT FROM SIDE LOT LINE
RENCE
PLAT BOOK 16, PAGE 94
REF DWG NO L H 23 -A
/
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71
Z(nE.i.rYL. (I h Vei da. ,ti�-:A-1 40
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CRESCENT LAND B TIMBER ,CORP
LAKE HICKORY
LOTS
LOT 95
CLINES TOWNSHIP
CATAWBA COUNTY NC
SCALE I =100 OCTOBER 14 1983
MISC BOOK NO 443 B 498,721 OWG NO L H 23 -A -7
KNOW ALL MEN BY THESE PRESENTS, that 1 Miles J.
Boyer hereby certify that 1 am Vice President of Crescent
1 a , 1 P F,mb ^.r rjrn , and that C L R T Corp Is the owner
th„ P9• •I , . ' 7 T Cam does
s :Ss
,is
L D*Amsult `
the I ^.Li
Timber Carp by i Ii-r. - -- i•c .a NO at
Pais q4 County Registry
i
STATE OF NORTH rAROtfNA
1'TIEWavbiaa, _ ^'•m
SEAT /S� h/%�Ye ••E•w.8.
: �
22, 1986
••,,.• CNt...... .
NOPT.
N1.... i "F ^^ ".'TY
M m 5.w .n
c sir
mrveror Ery{InM
STATE Of NOPT4 rARm IMA
6{1MN 'm,NrY 1
1�
r' ,11 rT 1)`I OF `°PRn,AL 4H1 '985
El
1` RECREAT ION LOT 6
/ JAMES EDWARD 474RONER
(/
JO
NOTE
BUILDING SETBACK LINES ARE
30 FT FROM ROAD RIGHT OF WAY LIMIT
30 FT FROM LAKE BOUNDARY AND
IS FT FROM SIDE LOT LINE
RENCE
PLAT BOOK 16, PAGE 94
REF DWG NO L H 23 -A
/
4�r/� %%�
/YO'tTN L_�Y/iO[/NR
71
Z(nE.i.rYL. (I h Vei da. ,ti�-:A-1 40
�oA/c L �x Fad ao?
CRESCENT LAND B TIMBER ,CORP
LAKE HICKORY
LOTS
LOT 95
CLINES TOWNSHIP
CATAWBA COUNTY NC
SCALE I =100 OCTOBER 14 1983
MISC BOOK NO 443 B 498,721 OWG NO L H 23 -A -7
KNOW ALL MEN BY THESE PRESENTS, that 1 Miles J.
Boyer hereby certify that 1 am Vice President of Crescent
1 a , 1 P F,mb ^.r rjrn , and that C L R T Corp Is the owner
th„ P9• •I , . ' 7 T Cam does
s :Ss
,is
L D*Amsult `
the I ^.Li
Timber Carp by i Ii-r. - -- i•c .a NO at
Pais q4 County Registry
i
STATE OF NORTH rAROtfNA
1'TIEWavbiaa, _ ^'•m
SEAT /S� h/%�Ye ••E•w.8.
: �
22, 1986
••,,.• CNt...... .
NOPT.
N1.... i "F ^^ ".'TY
M m 5.w .n
c sir
mrveror Ery{InM
STATE Of NOPT4 rARm IMA
6{1MN 'm,NrY 1
1�
r' ,11 rT 1)`I OF `°PRn,AL 4H1 '985