20140359 Ver 1_Application_20140410

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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 five (5) copies of this application and supporting
information as well as a non - refundable application fee to the Division of Water Quality of $240.00
for impacts to lake bottom of less than 1 acre and $570.00 for impacts to lake bottom of greater or
equal to 1 acre.
Applications should be sent to:
Division of Water Quality 401 Oversight/Express Review Permitting
�1
1650 Mail Service Center g L[NR 1© 2 014
Raleigh, NC 27699 -1650 w,,� _ aranch
I. Applicant Information
1. Owner /Applicant Information
Name: 1.2QV& o cknl M olrc; a zo&y
Mailing Address:
ON
Telephone Number: 3,Wo D f� —6��� Fax Number:
E -mail Address:
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: Ck v2 Yr�
Company Affilia ion: �(` 2P,c�4 GSa !' v
Mailing Address: p E o Z 515-
60:4 611 kX MC ,?912 / b
Telephone Number: d.?�"�y3_ S /Jr=1 Fax Number:
E -mail Address: 1�e /2 -14 �+6n Z 4JTS04rKa y e . [
H. 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 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 /
County: R aA e-r` fi rA Nearest Town: _ _ L.. are �
Subdivision name or,site address (include phase/lot,number): MZrvto�; OA LQ U , L3`b
Directions to site please include road numbers, landmarks, etc. (This is not necessary if an adequate - -
vicinity map is included)-.
2.
3.
4.
5
Describe the existing land use or condition of the "site at the time of this application:
Property size (acres):
Nearest body of water (stream/nvef /sourid/ocean/,lake): La ke,
Describe the purpose of the�proposed work. 3 h 6 C
i r'
6. List the type of equipment to be used to construct the project• _ _
7. Amount of `impact (including all excavation, backfi'll, rip ra b re5 1 w lls etc.) below the _
normal pool 'lake level in square feet or acres:
8.a. Amount,of impact (including all clearing, back,fill, excavation, rip rap, retaining walls, etc.)
above the normal po l lake level and 50'feet'land -ward m,square feet,or acres:
8:b. Please describe vegetation above ,the normal pool `lake level and 50 feet landward to be impacted
(number of•trees for instance):
Signature Date
is valid only if an authorization letter from the applicant is provided.)
I

To whom it may concern:
I
David and Marcia 'Baker hereby authorize Jay Freeman to serve as our agent to
construct a Rip -Rap sea wall on our lake front lot property on Lake Lure. Jay is
authorized to sign permits and any other necessary documents to achieve
authorization to construct the erosion control Rip -Rap. If you have any questions
please call me at 33& 813- 029,9.
avid L Baker
Marc' aker

Rutherford County, NC Print Map
http://arcgis.webgis.net/nc/Rutherford/printable.as
Rutherford Countv, NC
Disclaimer: The information contained on this page is taken from aerial mapping, tax mapping, and public records and is NOT to be construed or
used as a survey or'legal description'. Only a licensed professional land surveyor can legally determine precise locations, elevations, length and
direction of a line, and areas.
Parcels
GPIN: 0652130472010000
ST SUFFIX: HWY
Sale Price: 100000
Map Block Lot: 502 1 36
ST NAME: MEMORIAL
Neighborhood Desc: RESIDENTIAL LAKE
Owners Name1: BAKER DAVID L
Census Block: N
Neighborhood Code: L30B
Owners Name2: BAKER MARCIA T
Road Type: S
Deed Book and Page: 1068/196
Address 1: 3636 FORSYTHIA TR
Property Desc: 0.05AC PB34 PG 95
Deed Date: 8/1/2013
City: CLEMMONS
Township Code: 02
Nbr Land Segment: 1
State: NC
Numb of Bldgs: 2
Zip: 27012
Account Number: 15264181
Bldg Value: 1800
Acres: 0.05
Land Value: 80000
Property Address: MEMORIAL HWY
Total Value: 81800
Tax PIN: 219390
Stamps: 200.00
Attributes at nnint, N R9491 C; F 1nc;n7n1
Census Tracts
Tract: 9603
Soils
Soil ID: RaE
Zoning
Commissioners Districts
Fire Service Districts
Zoning Class: CG
Name: Chimney Rock
District: undefined
City: LAKE LURE
New Name: 06A
Voter Districts
Precinct: Chimney Rock
Commission: 5
Township: Chimney Rock
init: start
init: done
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Rutherford County, NC Print Map
http: / /arcgis.webgis.net /nc /Rutherford /printabL.as
Rutherford County, NC
Disclaimer: The information contained on this page is taken from aerial mapping, tax mapping, and public records and is NOT to be construed or
used as a survey or'legal description'. Only a licensed orofessional land surveyor can legally determine precise locations, elevations, length and
direction of a line, and areas.
Parcels
GPIN: 0652130472010000
ST SUFFIX: HWY
Sale Price: 100000
Map Block Lot: 502 1 36
ST NAME: MEMORIAL
Neighborhood Desc: RESIDENTIAL LAKE
Owners Name1: BAKER DAVID L
Census Block: N
Neighborhood Code: L30B
Owners Name2: BAKER MARCIA T
Road Type: S
Deed Book and Page: 1068/196
Address 1: 3636 FORSYTHIA TR
Property Desc: 0.05AC PB34 PG 95
Deed Date: 8/1/2013
City: CLEMMONS
Township Code: 02
Nbr Land Segment: 1
State: NC
Numb of Bldgs: 2
Zip: 27012
Account Number: 15264181
Bldg Value: 1800
Acres: 0.05
Land Value: 80000
Property Address: MEMORIAL HWY
Total Value: 81800
Tax PIN: 219390
Stamps: 200.00
Attrihutps at nnint• N R7d71F F 1r)rn7r11
Census Tracts
Tract: 9603
Soils
Soil ID: RaE
Zoning
Commissioners Districts
Fire Service Districts
Zoning Class: CG
Name: Chimney Rock
District: undefined
City: LAKE LURE
New Name: 06A
Voter Districts
Precinct: Chimney Rock
Commission: 5
Township: Chimney Rock
init: start
init: done
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of 2 3/7/2014 10:29 AM