20051672 Ver 1_Application_20050830

2oa5~s72
APPLICATION FOR DEPARTMENT OF THE ARMY PERMIT I OMB APPROVAL NO. 0710-0003
/33 CFR 3251 Expires December 31, 2004
The Public burden for this collection of information is sestimated to average 10 hours per response, although the majority of applications should require
5 hours or less. This includes the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and
completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of
information, including suggestions for reducing this burden, to Department of Defense, Washington Headquarters Service Directorate of Information
Operations and Reports, 1215 .Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302; and to the Office of Management and Budget,
Paperwork Reduction Project (0710-0003-, Washington, DC 20503. Respondents should be aware that notwithstanding any other provision of law,
no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control
number. Please DO NOT RETURN your form to either of those addresses. Completed applications must be submitted to the District Engineer having
jurisdiction over the location of the proposed activity.
PRIVACY ACT STATEMENT
Authorities: Rivers and Harbors Act, Section 10, 33 USC 403; Clean Water Act, Section 404, 33 USC 1344; Marine Protection ,Research and
Sanctuaries Act, 33 USC 1413, Section 103. Principal Purpose: Information provided on this form will be used in evaluating the application for a
permit. Routine Uses: This information may be shared with the Department of Justice and other federal, state, and local government agencies.
Submission of requested information is voluntary, however, if information is not provided the permit application cannot be evaluated nor can a permit
be issued.
One set of original drawings or good reproducible copies which show the location and character of the proposed activity must be attached to this
application (see sample drawings and instructions) and be submitted to the District Engineer having jurisdiction over the location of the proposed
activity. An application that is not completed in full will be returned.
1. APPLICATION NO. ~ 2. FIELD OFFICE CODE ~ 3. DATE RECEIVED ~ 4. DATE APPLICATION COMPLETED
/ITFMC RF/ nw rn Ett` ~u t cn av evor tnemn
5. APPLICANT'S NAME 8. AUTHORIZED AGENT'S NAME AND TITLE lan agent is nor requitedl
`
~Y'-r ~ e- t f !
r ~ .~.Sc~Gi~~
6. APPLICANT'S ADDRESS <
`~~~~ I~rn~r~ee.~ ~Jr ~ v~ 9. AGENT'S ADDRESS
~/~"~ /1'?1cQl~~ ~~
~~u~`~l~ ~~ ag31 s~~~n P(`~,~s , ~~ ~~~s7
7,. APPLICANT'S PHONE NOS. W/AREA CODE 10. AGENT'S PHONE NOS. W/AREA CODE
a
Residence ~ ~o -- ~~ b - ~~ ~
. a. Residence
b, Business l~ - (~~1 _ /7 / ~~ b. Business ~ /Q •- (0~~~ ~~' (~
I hereby authorize, ~L.Lt"', tJCaV [_lli'TL°I'" to act in my behalf as my agent in the processing of this application and to
rurnish, upon request, supplemental information in support of this permit application.
APPLICANT'S SIGNA'
_- _~ ~ -
DATE
LOCATION AND DESCRIPTION OF
~~
12. PROJECT NAME OR TITLE lseeinsrructions~ ~ ~ C
c~-v1c ~ ~a~ ~ Lc'I~ --~c~~ ~~°tk~~ ~~~~~vi,+~.-~..~ ND ~ Nni
m C~
-- ~ ~ C l=~
13. NnAME OF WATERBODY, IF KNOWN /ilepp/icableJ
(~ Vzkl~~( Clr~..~
15. LOCATION OF PROJECT /~ ~
fl9~(~ V+ ,~ CI N• ~~, 1 ~ ~-
COUNTY STATE
?6. OTHER LOCATION DESCRIPTIONS, IF KNOWN, lseeinstructionsl
.~----~,
14. PROJECT STREET ADDRESS i/teppiceeiel
11-t-j~--~Lri (.~ J ~'~ ~c~,.~ f
C '\'~
c
17, DIRECTIONS TO THE SITE
Ls-t u;~st ~- fro? l`r~-~.~.~.y ~~'•. ~ ~ ~l( /~}rvr~~°~ccr;~/ ~~~.~
4 u 7 EDITION OF FEB 94 IS OBSOLETE. (Proponent: CECW-OR)

18. Nature Of ACtlVlty (Description of project, include //feerwes/ ~ ~
~'
~ u~ S~p~",~'~
19. Project PurpOSe (Describe the meson or purpose of the project, see instrudionsl
USE BLOCKS 20-22 IF DREDGED ANDIOR FILL MATERIAL IS TO BE DISCHARGED
20. Reason(s) for Discharge t ~\
21. Type(s) of Material Being Discharged and the Amount of Each Type in Cubic Yards
22. Surface Area in Acres of Wetlands or Other Wa ers Filled /see irnsrrucrionsl
23. Is Any Portion of the Work Alre dy Complete? Yes ,N~ IF YES, DESCRIBE T E OM,PLE~E,D, ~yORK
~` ~
24. Addresses of Adjoining Property Owners, Lessees, Etc., Whose Property Adjoins the Waterbody (If more than can be entered here,
pleaach a supplemen, tal list),
25. List of Other Certifications or Approvals/Denials Received from other Federal, State or Local Agencies for Work Described in This Application.
AGENCY TYPE APPROVAL' IDENTIFICATION NUMBER DATE APPLIED DATE APPROVED DATE DENIED
.~
ould include but is not restricted to zoning. building and flood plain permits
26. Application is hereby made for a permit or permits to authorize the work described in this application. (certify that the information in this
appiication is complete and accurate. I further certify that I possess the authority to undertake the work described herein or am acting as the
duly authorized agent of the applicant.
~ 0 4S
SIGNATURE OF APPLICANT DATE S GNATURE OF AGENT DATE
The application must be signed by the person who desires to undertake the proposed activity (applicant) or it may be signed by a duly
authorized agent if the statement in block 11 has been filled out and signed.
18 U.S.C. Section 1001 provides that: Whoever, in any manner within the jurisdiction of any department or agency of the United States
knowingly and willfully falsifies, conceals, or covers up any trick, scheme, or disguises a material fact or makes any false, fictitious or
fraudulent statements or representations or makes or uses any false writing or document knowing same to contain any false, fictitious or
fraudulent statements or entry, shat! be fined not more than S 10,000 or imprisoned not more than five years or both.

# Zos:
1) Bruce M. Wheeler
4431 Ferncreel< Drive
Fayetteville, NC 28314
2) J.K. Lormand
505 Lost Tree Court
Fayetteville, NC 28314
3) Robert Fietsam Jr. and wife
4423 Ferncreek Drive
Fayetteville, NC 28314
4) Buckhead, LLC
P.O. Box 53309
Fayetteville, NC 28305

.~
\ ~.
\ J. K. LORMAND
DB. 3397 PG. 492
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