20140497 Ver 1_Shoreline Stabilization_20140515

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20140497
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 $240.00
for impacts of 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 D
1650 Mail Service Center :MA 014 Raleigh, NC 27699 -1650 1
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I. Applicant Information . w�r,ds a sk,,,,�. 0A— M -_—
Owner /Applicant information
Name:
Mailing
Telephone Number: 7 ��- — 7` 5� 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 ownerlapplicant.)
Name:
Company Affiliation:
Mailing Address:
Telephone Number:
E -mail Address:
11. Project information
Fax Number.
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.
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1. Location
County:� Nearest Town:
Subdivision name or site ` _address (include phase/lot number):i�ts�
Directions to site - please include road numbers 'landmarks, etc. (This_ is .not necessary &an adequate,
vicinity map is included):z�L
2: Describe the existing and use =or condition ,of the site at the, time of -this a hcation: , /P-
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Property size (acres):
Nearest body of water
Describe the purpose c
6. List the type of equipment to be used to construct theproject:
7. Amount of impact (including all excavation, backfill, rip rte, retaining walls, etc.) below the
normal pool lake level in square feet or acres: ZZ
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 landXard in syluar�� or acres:
,Y - •�- ,
8.b. Please describe vegetation above the normal pool Iake level and feet landward to be impacted
(number of trees for instance):
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ApplicantfAgenfs Signature bate
(Agent's signature is valid only if an authorization Ietter from the,applicant is provided.) �-�

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