20161085 Ver 2_Agent Authorization_20220112 (3)

Duke Energy Lake Services
Guidance for Completing an Excavation Permit Application
Note: If you are proposing excavation in association with the permitting of a new
or expanded facility under the Marina or Conveyance Programs, you do not need
to complete this application. Instead, you should incorporate the excavation
request into the permit application for the marina/conveyance using the
appropriate application.
Step 1: Contact Duke Energy Lake Services
Complete "Part I" of the application and develop a drawing of the proposed excavation area.
Contact Duke Energy Lake Services to schedule a site visit. Lake Services will conduct a site
visit to determine if Duke Energy will accept an excavation permit application for the proposed
work. If the Lake Services representative determines the application process may proceed,
he/she will initial Part I of the application.
Step 2: Draft Application Development
Complete Parts II-III.A-G and Part V of the Excavation Permit Application.
Step 3: Agency Consultation
Send the draft application developed during Step 2 to the agencies for review and comment on
the proposed activity. Refer to the Agency / Organization List available from Duke Energy to
determine which federal, state, regional, and local agencies and organizations require
consultation or review.
Note: Duke Energy reserves the right to require consultation with additional organizations
beyond those included in the Agency / Organization List.
Each agency / organization must be provided at least 30 days prior notification. Evidence must
be provided (e.g., response letter or Certified Mail receipt) in the complete application to show
each agency / organization was given the opportunity to review the proposal.
Consultation letters must be dated within the two years preceding Duke Energy's receipt of the
application. All permits must be valid at time of application and have a term longer than the
projected schedule for completing the permitted project.
What to Expect During Agency Review and Comment:
• You will typically receive a letter from each agency / organization either documenting its
concurrence with your proposal, requiring additional information, recommending
modifications, or offering no comment. You must address each agency's / organization's
comments with a follow-up letter and in your final application as described in part IV.
• If you do not receive any documentation from an agency / organization within 30 days of its
receipt of your proposal, you must provide the agency / organization with a follow-up letter
requesting comment on your proposal within 15 days from the date of the follow-up letter. If
you still do not receive any response as a result of the second letter, type "NO RESPONSE"
Duke Energy Page 1 of 13 rev 11/22/21
Excavation Program

at the top of the follow-up letter and include it in the application along with proof of the
agency's / organization's receipt of the letter (e.g., Certified Mail receipt). You may proceed
with the application process recognizing, however, that if its comments come later in the
application process, you will be required to address them.
From the United States Army Corps of Engineers (Corps): (** Note — The Corps may have
additional forms to submit for your proposal and an additional fee.) If the excavation can be
done under the requirements of the General Permit (GP) or a Nationwide Permit (NWP), you
will typically receive a copy of the Corps' tear sheet documenting authorization and
providing any additional instructions. If the excavation isn't covered under the GP or a
NWP, you'll be required to obtain an individual 404 Dredge and Fill permit from the Corps.
You must receive written documentation from the Corps that your application either (1)
meets the requirements of the GP or a NWP or (2) the proper 404 Dredge and Fill permit has
been received before Duke Energy can process your application.
From the North Carolina Department of Environmental Quality (NCDEQ), Division of
Water Resources: (Note NCDEQ may have additional forms to submit for your proposal
and an additional fee) If the proposal meets the requirements of the Clean Water Act Sect,
401 Water Quality Certification, you will typically receive a letter from the NCDEQ Division
of Water Resources documenting Sect. 401 Certification and providing any additional
instructions. You may also receive a letter requiring additional information or
recommending modifications. You must receive written documentation from NCDEQ
noting any required Sect. 401 Certification has been received before Duke Energy can
process your application.
• From the North Carolina Wildlife Resources Commission (NCWRC): If you do not receive
any documentation from the NCWRC within 30 days of their receipt of your application, you
may proceed with the application process without submitting a follow-up request,
recognizing however if comments come in later in the application process, you will be
required to address them.
From the South Carolina Department of Health and Environmental Control (SCDHEC):
(Note — SCDHEC may have additional, forms to submit for your proposal and an additional
fee) The SCDHEC conducts a joint application process with the USACOE in S.C. If the
proposal meets any applicable requirements of the Clean Water Act Sect. 401 Water Quality
Certification, you will typically receive a letter from SCDHEC documenting Sect. 401
Certification and providing any additional instructions. You may also receive a letter from
USACOE requiring additional information for the agencies participating in the joint
application process. You must receive written documentation from SCDHEC noting Sect.
401 Certification has been received if required before Duke Energy can process your
application.
• From the South Carolina Institute of Archaeology and Anthropology (SCIAA): The applicant
must wait 30 days after receiving the signed postal returned receipt. If a response from
SCIAA has not been received by this time you may proceed with the application process
without submitting a follow-up request, recognizing however if comments come in later in
the application review process, you will also be required to address them.
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Excavation Program

Step 4: Final Application & Submittal to Duke Energy
Following the consultation process, finalize the application. The final application submitted to
Duke Energy should incorporate all comments and recommendations provided by agencies and
organizations during the agency consultation process as well as copies of all permits received. In
addition to the final application include the following:
• One check payable to Duke Energy for the application fee and security deposit
• If applicable, a separate check payable to the appropriate Habitat Enhancement Program fund
• Signed Excavation Program Applicant's Agreement
Note: Co -applicants must also submit the application fees and applicable HEP fees with the
application.
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Excavation Program

Duke EnerLyy Excavation Permit Appikation Form
FOR DUKE ENERGY USE ONLY
Duke File No.
Application Fee $ Security Deposit $ Check # Date Reev'd Initials
Date of Duke Energy Lake Services, applicant and/or contractor on -site inspections Date i iX& ZAnitials dQKA
Date Final Protection/Avoidance Area Markings Field - Verified
Approved to Start Work By * :
Date Completion Required
Date Passed Closeout Inspection's
Initials
Date
(Print) (Sign)
Date of Any Approved Extension Initials
Initials
Any Stop Work Orders or SMG Violations*? (check one) ❑'Yes ❑No (yYes, explain in PART V)
Date Deposit Refunded Initials Date Permit Database Updated Initials
* Forward copy of approved application (all pages, plus any attachments that Duke Energy changed) back to applicant
with Approval Letter and highlight any changes. Fite copies of Approval and Close-out Checklists and any Stop Work
Orders with application.
Part I. Applicant Information (Please Print)
Name_' )&, ^!S5 K n Telephone 70 + 6 rya z & 1 9-4
Email address: C� E $ I S I�4C6XIAPL ,, e,a�
Lake Address
t2.3 F_sr 5 A-PNtyc-
i &OZEsJILLEO >AC_ 2011-1
Mailing Address (if different)
Contractor Company 1&I OAT'_ R 5 In 11 E20615 SFt t QS L
Contractor Contact Person -A `M Telephone
Contractor Email Address: 134t tti�_,�iGr%iQT��SfDE Dbe-k- S - C-vwt._
LAKE LOT INFORMATION
Lake b� e2,2 kounty ,1R -peu City tje-),rykcs,O[uZ'State Tax Map No
Subdivision
Lot / Section No. 38 4- _ Lot Size "(abAcres
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Excavation Program

Duke Enerzy Excavation Permit Application Form
Security Deposit Refund Information
The security deposit will be refunded after the excavation permit has expired if no violations of
the approval occurred. The applicant will receive the security deport refund at the mailing
address in Part I unless an alternative recipient is identified.
Send the security deposit to an alternative recipient? (check one) ❑Yes kNo (If Yes,
include name and mailing address below.
Name:
Mailing Address:
Tax ID:
Are there any Co -Applicants*? (check one) ❑Yes ONo (If Yes, include names, street
addresses or lot numbers, pier numbers, phone numbers, and email addresses in Part V —
Additional Information)
* Co -Applicants exist when the proposed work is being done under a single application, will be
performed by a single contractor as one continuous project, and is done to benefit multiple
owners / lease holders of Project -front properties within a single development. There can be no
more than 4 co -applicants in addition to the lead applicant on any application.
Do not continue the application until an on -site inspection has been conducted between a
Duke Energy Lake Representative and the applicant and/or the excavation contractor.
NOTE. Initialling this portion of the application by a Lake Representative in no way
constitutes approval or eminent approval of the excavation or any other lake use permitting
activity.
Date of on -site inspection OL4 'ZZ-
Initials (Duke Energy) (applicant/contractor)
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Excavation Program

Duke Energy Excavation Permit Application Form
Part IL Description of Project
A. Basic Information
1. Type of excavation: (check one) ❑ New excavation kMaintenance excavation
2. Purpose of excavation: (check one) ® Boat Access Channel
❑ Water Intake Channel ❑ Wastewater Discharge Channel
❑ Other (specify): ]REm,,L�_stLE Pyrewpao ExiliiPal D44,k 1-tV-T
3. Lake user category: (check one) IWrivate ❑Residential Marina
❑Commercial Marina []Public
❑Other (spec):
4. Max. Excavation Area Dimensions (ft): Length Width Depth
(Note: include additional area dimensions if necessary so response to #5 below equals max. area
dimensions in #4)
5. Volume of Excavated Material (TOTAL far the project): Zgc7 Cubic yards
5. 'Type of material removed (applicant determines by field sample if practical):
M uA 4 Si it
7. Excavation Site area: 7. is Acre (s) Disposal Site area: _33 Acre
(s)
S. Total Disturbed Area (including equipment staging area): >-F t o Acre (s)
9. Does the project meet the requirements of the applicable General Permit? (check one)
ELYes ❑No
10. Do you claim title to the disposal area? (check one) Wes ❑No
11. Do you claim title to the equipment staging area? (check one) ®.Yes ONo
12. Are there any water -treatment facilities within 50 feet of the proposed excavation area?
(check one) ❑Yes IANo
(If Yes, spec):
13. How will the excavated material be entrapped and the erosion controlled? (e.g. see attached
erosion control plan and disposal area design):
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Duke Energy Excavation Permit Al2plication Form
14. Type(s) of excavation equipment to be used:
QA�ZbE k0-1 1b Ex o
15. Will waters or wetlands be crossed in transporting equipment to or from the site?
(check one) ❑Yes QSINo
16. Will return water re-enter the reservoir? (Check one) ❑Yes %No ❑NIA
(If Yes, s eci oint(s) gfre-entry and show on Excavation Area Drawing)
17. Is there an existing facility (e.g. pier) that access is being maintained to by conducting the
excavation? Kyes ❑No
(ff Yes, provide the existing permit number. If No, include a scaled drawing of the proposed
facility). Permit # _[72 L?z
18. Total planned duration of the work (Include first equipment mobilization, excavation
through final mitigation measures complete):
START / FINISH /
(Month) (Year)
(Month) (Year)
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Excavation Program

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Duke EneMV Excavation Permit Application Form
C. Applicant's Signatures
Comments:
Applicant Name (print) _
Applicant Signature*4=
Date i ` G - P7d
Co -Applicant Name (print)
Co -Applicant Signature*
Co -Applicant Name (print)
Co -Applicant Signature*
Co -Applicant Name (print)
Co -Applicant Signature*
Co -Applicant Name (print)
Co -Applicant Signature*
Date
Date
Date
Date
*Per my signature, the information provided in this application is correct to the best of my
knowledge.
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Excavation Program

Duke Enerpv Excavation Permit Application Form
Part III. Additional Information
A. Deed and Survey Plat: A copy of the deed and registered survey plat or other instrument
under which each applicant and co -applicant claims title to the affected property (the
shoreline adjoining the excavation area, equipment staging area, area crossed by any spoil
and return water lines, and the disposal area). If the applicant(s) is(are) not the owner(s) of
said property, then forward a copy of the deed and registered survey plat or other instrument
under which the owner(s) claim title plus written authorization from the owner(s) to carry
out the project on their land.
B. Excavation Area Drawing: An accurate drawing of the area to be excavated. The drawing
must show at a minimum, a North arrow; the boundaries and acreage of the proposed
excavation area and equipment staging areas; lake, county, city, cove, tributary, road and
subdivision names and lot numbers (as applicable); property corners for project front lots;
the full pond elevation contour and lines dividing the cove width into equal thirds (as
applicable); approximate volume in cubic yards of the material to be excavated; point(s) of
return water re-entry; the boundaries of any adjoining areas that are to be specifically
avoided or protected during the work and the location (address) of the disposal area for the
excavated material. [NOTE: A copy of this drawing must also be provided to the
excavation contractor to ensure restricted areas are not impacted.]
C. Disposal Area Drawing: An accurate drawing of the proposed design for the disposal area.
The drawing must show at a minimum, a North arrow; the boundaries and acreage of the
proposed disposal area; lake, county, city, cove, tributary, road and subdivision names and
lot numbers (as applicable); the full pond elevation contour (unless disposal is well away
from the lake); the boundaries of any adjoining areas that are to be specifically avoided or
protected during the work; the location (address) of the excavation area from which the
material came and a statement of the disposal area's capacity with all dimensions labeled
that were used in the volume calculation. [NOTE: A copy of this drawing must also be
provided to the excavation contractor to ensure restricted areas are not impacted.]
Also note for projects larger than one (1) acre in North Carolina. including excavated,
equipment staging, and disposal areas, you must subunit an erosion control plan. For
projects larger than two (2) acres in South Carolina, including excavated, equipment staging
and disposal areas, you must submit an erosion control plan. For projects < two (2) acres in
South Carolina, you must submit a completed standard reporting form for construction sites
disturbing two (2) acres or less to the South Carolina Dept. of Health and Environmental
Control (SCDIIEC) - Stormwater Management
D. Vicinity Map and Driving Directions: A vicinity map and directions by road showing
directions to both the excavation area and disposal area. Include the latitude and longitude of
both the excavation area and the disposal area.
Part IV. Agency Reviews and Approvals
Begin this section with a summary table of all agencies consulted and applicant response to
agency comments as shown in the example table below. Agencies should be listed in the order
Duke Energy Page 1 i of 13 rev 111222021
Excavation Program

Duke Enemy Excavation Permit Application Form
shown in the Agency/Organization List. Consultation letters must be dated within the two years
preceding Duke Energy's receipt of the application.
Table IV-1. SampleAgeng Comment and Response Table
Agency Comment
Applicant Response
AgencyAgenLy 1
The activity is approved as proposed.
NA
Agency 2
The on -site well provides drinking water to the
Contacted Mr. Smith on 1/1/20xx. No
public. Please contact Mr. Smith to discuss the
further action needed.
proposed changes and potential issues
associated with your proposal.
You must contact us immediately if
Applicant will contact Agency 2 if
endangered species are Iocated during the
endangered species are located during
course of construction.
construction
Agency 3
Requested agency comments on 1l1/20xx and
NA
again on 2/l/20xx. No response as of
2/16/20xx.
Agency 4
Section 401 Water Quality Certification
Applicant will comply with the conditions of
the 401 Water Quality Certification
Following the table of agency comments and applicant responses, include a table of permits and
certifications issued by the reviewing agencies. As with the table of agency comments and
applicant responses, agencies should be listed in the same order as they are listed in the
Agency/Organization List.
Table IV-2. Sample Agency Permits and Certifications Table
Agency
PermitiCeriifcation Name
Date of
Date ofIssuance
Expiration
Agency 1
Surface Water Withdrawal Permit
Agency 2
Section 401 Water Quality Certification
Following the two summary tables, include a copy of all correspondence to and from any local,
regional, state and federal agencies or other organizations with which you are required to consult,
including any required permits (e.g., Section 401 water quality certifications, Section 404
dredge/fill permits, building permits, etc.) or other approvals or comments which have been
obtained from these organizations regarding this activity. Include a copy of any local, regional,
state or federal regulations or guidelines that will be followed. All permitting issues must be
resolved and clearly documented. Correspondence should be organized in the order the agencies
are listed on the Agency/Organization list with the applicant's request for comments followed by
additional correspondence in chronological order. All permits must be valid at time of
Duke Energy Page 12 of 13 rev 11122Y2021
Excavation Program

Duke Eneray Excavation Permit Application Form
application and have a term longer than the projected schedule for completing the permitted
project.
Part V. Additional Information
Provide relevant additional information. Reference previous parts as applicable. Include the
FERC-required Environmental Assessment if you were directed to do so during the initial site
visit. If there are co -applicants, this is where their information would be provided (see Part I).
Duke Energy Page 13 of 13 rev t ,221202t
Excavation Program

Excavation Project User's Agreement Letter
(Please fill in the blanks. Please Print)
Da ` ��f o Z Z.
TO: Duke Energy
c/o Lake Services - EC 12Q
526 S. Church Street
Charlotte, NC 28202
RE: Excavation For (Subdivision and Lot #'s or Other Project Name)
) ODP-MW / XQCD Z 1 MVQR1UZZ
(Applicant's_ full name) hereby agrees to comply with all
recommendations, requirements and/or conditions of Duke Energy, General Permit(s) (if
applicable) and other federal, state and local agency requirements pertaining to the application to
excavate for the purpose of aW=ce-,55
In addition, 11we have read and agree to comply with Duke Energy's current Shoreline
Management Plan (SMP) or other applicable guidelines, much of which is repeated herein, and
understand that written authorization must be obtained from Duke Energy prior to beginning any
activity within the Federal Energy Regulatory Commission (FERC) project boundary or on Duke
Energy property associated with a reservoir, collectively referred to as Project Boundary. The
excavation will be completed as described in the approved application and within eighteen (18)
months from the date of written approval by Duke Energy, unless specifically noted otherwise in
the application or unless Uwe obtain approval for a single, time extension (maximum of one year)
in writing from Duke Energy. Uwe understand that if the SMP or other applicable guidelines or
rules change during any extension period, Uwe will be expected to comply with the new
requirements to the maximum extent practicable. Uwe also recognize that failure to complete the
excavation within this build -out period will require the filing of a new application within the then -
current SMP or other applicable guidelines and the new application must include any applicable
fees and security deposits.
I/we attest to be the owner(s) or lease holder(s) of the land immediately adjoining the Project
Boundary where the excavation activity is to take place, or if not the owner or lease holder,11we
have included proof of title to the property and written authorization from the owner(s) or lease
holder(s) to carry out the proposal within the Project Boundary adjacent to their land.
Uwe attest to be the owner(s) or lease holder(s) of the land that will be used for equipment
staging and disposal of excavated material or if not the owner or lease holder, Uwe have included
proof of title to the property and written authorization from the owner(s) or lease holder(s) to
carry out the work on thcir land.
Duke Energy Page 1 Re,: 4/612020

I/we understand that all excavation work must be done directly in front of my/our property and as
specified in Duke Energy's approval. Uwe also understand that access channels must run
perpendicular to the shoreline while within the third of the cove area that is nearest my/our
property.
I/we understand that for proposed excavations, Uwe must notify the appropriate local, state and
federal agencies in advance of the activity by sending them a completed copy of Dune Energy's
Excavation Permit Application Form and other required information. I/we understand that
written authorization and/or other permits may be required by some of these agencies and such
required authorizations must be obtained before I/we submit the final application to Duke
Energy.
At FERC-licensed reservoirs, I/we understand that except for maintenance excavations, any
excavation exceeding 2000 cubic yards of material removed or any excavation or shoreline
stabilization work needed to support an application that requires FERC review does itself require
specific review and approval by the FERC before Duke Energy can issue any approvals.
I/we agree that unless specifically approved otherwise in the application, explosives will not be
used as part of this excavation activity.
I/we understand that every reasonable effort must be made to minimize any adverse impact on
fish, wildlife and other natural resources.
I/we understand that applicants in South Carolina proposing excavations that are not covered
under the General Permit, or are greater than 150 cubic yards, must receive prior written
authorization from the South Carolina Department of Health and Environmental Control
(SCDHEC) or the US Army Corps of Engineers (as applicable) before submitting the completed
application to Duke Energy.
I/we agree that excavation activities will not occur during the months of March, April, May and
.Lune because of the potential impacts to fish spawning areas.
I/we understand that trees and vegetation growing within or adjoining the lake play an important
role in its overall environmental condition, and the ecological benefit the vegetation has on fish
and wildlife habitat directly supports a sound and healthy lake environment. I/we also understand
that unauthorized removal of shoreline vegetation (e.g. button bushes, willows, cattails, etc.)
and/or disturbance of the shoreline buffer may result in suspension or denial of lake use
permitting requests, forfeiture of security deposits and require re-establishment of vegetation at
my/our expense, particularly if the disturbance is found to be in violation of state or local
ordinances or impacts FERC project buffers.
Uwe agree all excavated material will be placed in upland areas, landward of the Project
Boundary, and confined to prevent erosion and sedimentation back into the lake or nearby
streams.
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Uwe agree to adequately stabilize all excavated material and all disturbed shoreline to prevent
erosion and runoff into the lake.
Uwe understand that the double handling of excavated material will not be allowed; therefore, all
excavated material must be placed above the Project Boundary in one handling.
Uwe have designed the hydraulic excavation process (if any will be used so that return water re-
enters the lake in the same general vicinity and cove as the excavation, to the maximum extent
practicable.
I/we agree that the proposed excavation will not be for the purpose of creating additional
shoreline, will not alter the Project Boundary or the full pond contour, and will not impact
threatened or endangered species, historic properties, or environmentally -important areas, unless
special public entity provisions were made in the application.
Uwe recognize that it is my/our responsibility to clearly locate in the field and label on my/our
work area drawings any areas that require specific protection or avoidance during this excavation
work. Examples of these protection/avoidance areas include but are not limited to, any
Environmental Areas, Natural Areas or Impact Minimization Zones as identified by Duke
Energy; jurisdictional wetlands; historic properties; rare or threatened species; and buried gas,
water, sewer, electric or communications lines. Uwe agree to provide mylour contractor with a
copy of these work area drawings showing these areas to stress the necessary protection
measures.
I/we agree that if any archaeological resources (e.g. pottery shards, Indian artifacts, etc.) are
discovered during the excavation, work shall be halted immediately. I/we will then notify Duke
Energy and the State Historic Preservation Office to determine what measures, if any, 1/we must
pursue to protect or salvage the archaeological resources.
1/we agree that any excavation from within the Project Boundary will not exceed the volume as
outlined in the application and will remove and disturb only what is absolutely necessary to
achieve the project's stated purpose.
Uwe agree to be fully responsible for the permitted lake use and Uwe understand that this
responsibility is considered to transfer automatically along with ownership and leases of the
adjoining tract.
Uwe understand Duke Energy representatives may issue Stop Work Directives for violations of
the SMP or other applicable guidelines and other consequences may result from such violations,
including but not limited to suspension or cancellation of approved permits, increases in fees,
modification or removal of non -complying structures and restoration of disturbed areas at my/our
own expense or loss of any consideration for future lake use permits. Uwe agree to immediately
comply with any Stop Work Directives, to fully cooperate with Duke Energy and other agencies
as necessary, and to perform the necessary remedial actions within the specified time frame.
DU-4 ErxW Page 3 R�46V202o

1/we agree to develop any required mitigation plans and to complete any required mitigation
activities at my/our own expense within the specified time frames. Uwe recognize that the
excavation work is not considered complete and deposits will not be refunded until the
mitigation requirements (if any) have been satisfactorily fulfilled.
Uwe a2ree to notifv Duke Energy by phone when the excavation is initiated and to ensure that
during the excavation period, I/we will p2st Duke Energy's approval letter in a clear wale roof
bgg at the 'ob site and visible from the water's edge.
I/rve agree to notify Duke Energy in writing when the excavation is completed (including any
required mitigation measures) and that the excavation was completed per the approved
application, so a close-out inspection can be performed.
Uwe recognize security deposits will not be refunded if any violations of the SMP, other
applicable guidelines, or this user's agreement occur.
I/we understand there will be no change in hydro project operations as a result of the excavation
and/or utilization of the excavated area.
Uwe agree to maintain the work area in a safe condition and to fully indemnify and save Duke
Energy harmless from any and all claims, liability, loss or damage that may arise from this
excavation project.
1/we understand that this user's agreement does not, in any way, constitute the transfer of any
rights in real property and that my/our use and enjoyment of FERC project and Duke Energy
lands and waters shall not hinder the general public's lawful use and enjoyment of the same.
Sincerely,
o
Applicant's Name (Print)
Co -Applicant's Name (Print)
Co -Applicant's Name (Print)
Co -Applicant's Name (Print)
Co -Applicant's Name (Print)
�C
Ppopul-icant's Sign re
Co -Applicant's Signature
Co -Applicant's Signature
Co -Applicant's Signature
Co -Applicant's Signature
DukeEnergy Page 4 Rev! q/&=O