20140528 Ver 1_More Info Received_20140619

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etc.), rip rap, excavation or dredging below Full Pond/ Normal Wate Le eFe-levations,
and construction access corridors. You may use the diagram provid w e ��J
application form.
Attach a photograph of the shoreline/ buffer proposed to be stabilized. (Include a scale
of some sort- a yard stick, shovel handle, etc.)
Location of the property (where work is to be conducted)
County: Nearest Town:
Subdivision name or site address (include phase /lot number):
Directions to site - please include road names and numbers, landmarks, etc.:
0
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): t, ar �
6. Property size (acres): �1
7. Lake/ river/ ocean adjacent to property: E.-a k-1 r
8. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): AdV S'Px zaaJj iD2 <--f
9. Will work be conducted from land? LJ From water? ❑
10. Total amount of disturbance (including all excavation, backfill, rip rap, retaining walls, etc.)
�"„ --i iwp 1nuPl/ Normal Water Level in square feet or acres:
' ' i 0 r /%_
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
Poch a * 5 K_PP� _or
square feet or acres: v _ ,�Ai i
--- --ter t '
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): F_— V-f r1 + i. , w rf k ;N
1`, t,
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Owner /Agent's Signature* [15A NCAC 02H .0502(f)1 Date
'Agent's signature is valid only if an authorization letter from the owner is provided.
Page 2 of 3
FORM. 55GP 10 -2013
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Please approximately sketch the following information on this plan
(please provide dimensions for each item, such as 10 ft. x 100 ft):
1) All proposed vegetation clearing (provide dimensions)
2) Location of rip rap or fill to' he placed above the Full Pond elevation
3j* Location of rip rap or fill to be placed below the Full Pond elevation
dM The location of any proposed structures such as buildings, retaining
vralfs_ docks, etc.
5) The location of any excavation or dredging bela>,v the Full Pond
elevation.
6) Location of construction access corridors.

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