20140611 Ver 1_Application_20140612

SEP -14 -2005 06:13 FROM:DWO- WETLANDS 9197336893 TO:918284953050 P:1 /5
PAID 20 140 6 1 1
The folloiving 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 strum 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 I 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 --- --
7f 3P
I. Applicant Information
JUN 1 6 2014
D NR - WA , WAL TY
1. Owner /App i cant Information ` Branch
Name: c_s; �D c . h
Mailing Address: —U
Telcphonc Number; '-1 y�k Tck � �'F-ax, Number;
E -mail Address: C % c �� a3 �) 1D�e .l` SO
2. Agent Information (A signed and dated copy of the Agent Authorization letter
must be attached if the Agent has signatory authori for the owner /applicant.)
Name: S A �L1� RS A V L
Company Affiliation-
Mailing Address:
Telephone Number: Fax Number:
E-mail Address:
II. Project Information
Attach a vicinity map clearly showing the location of the property with respect to
local landmarks sucb. as toxvns, rivers, and roads. Also provide a detailed site
plan showing property boundaries and development plans in relation to
surrounding properties._ You .tnay use the diagram, below to make a hand sketch of
09 -13 -2005 19:47 MARINE CONSTRUCTION CO 8284953040 PAaE1

SEP -14 -2005 06:13 FROM:DWO- WETLANDS 9197336893
TO:9182e4953050 P:2/5
your project. Also, see the example below for guidance. Both the vicinity map and
site plaza must include a scale and north. arrow. The footprints of all buildings,
impervious surfaces, or other facilities must be included.
n
County. � sh o P - �,� 1" Nearest Town: �u�a✓ ll
4
Subdivision name or site address (include phase/lot number):
Directions to site please include road numbers, landmarks etc. T!-! i not
ne es(sarypif an /adequate vie' it y map is included): -/� 4, ° ^ o
L , V, - V . . i ., L ., . l.�' , l h - j-r-� i 1, i/lc:..ir. - 6 , I h e '.k ^i • - --
2. Describe the existing land use or condition of the site at the time of this
application: Vcvd S r,, , C 1 S
3. Property size (acres): , 3 / S PC �-
4. Nearest body of water (strearn/river /sound/ocean / lake): a-
5. Describe the puipose of the Proposed work: S c S
6. List the type of equipment to be used to construct the project: ��� �, /'-�� � S � .� s -6, -
7. Amount of impact (including all excavation, backfill, rip rap, retaining walls, _
etc.) below the normal pool lake level in square feet or acres: G X (do `
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: /fir G O sr-
b. Please describe vegetation above the normal. pool lake level and 50.fect 1 � land- /
ward to be impacted (number of trees for instance): k v -F '. j % </
Applic 6nt7A�ent's Signature 3 Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
09 -13 -2005 19:47 MARINE CONSTRUCTION CO 8284953040 PAGE2

Print - Maps
LV bing Maps
970 Lake Vista Ln, Taylorsville, NC 28681
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Owner: WRIGHT JOYCE I
Mailing Address: 229 TOMLIN MILL RD
Physical Address: 970 LAKE VISTA LN
Parcel ID: 0019117
PIN: 3746319599
Deed Reference: 0516 2263
Alexander County
assumes no legal responibilty
for the information
contained on this map.
1:1,200
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Acreage:
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Fire District:
WITTENBURG FIRE
Structure Value:
$0
Land Value:
$69,900
Misc Value:
$30,543
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Owner: WRIGHT JOYCE I
Mailing Address: 229 TOMLIN MILL RD
Physical Address: 970 LAKE VISTA LN
Parcel ID: 0019117
PIN: 3746319599
Deed Reference: 0516 2263
Alexander County
assumes no legal responibilty
for the information
contained on this map.
1:1,200
0 0.0075 0,015 0.03 ml
0 0.0125 0.025 0.05 km
Acreage:
0
Fire District:
WITTENBURG FIRE
Structure Value:
$0
Land Value:
$69,900
Misc Value:
$30,543
Fair Market Value
$100,443
Tax Value:
$100,443
Account #:
9314772
Alexander County
June 10, 2014

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