20140465 Ver 1_More Info Received_20140725 (2)

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of some sort- a yard stick, shovel handle, etc.)
County:
EM
Nearest Town: Mooresville
Subdivision name or site address (include phase/lot number). The 7 Lot 72B
169 Rehobeth Lane Mooresville. NC 28117
Directions to site - please include road names and numbers, landmarks, etc.:
below the normal pool take level/ Normal Water Level in sq4pre feet or @cres&
Own &/Ag'ent's'SiF nature * Date
`Aoent's signature is vatic' only if an authorization letter ram the owner is provided.
FORM: SSGP 10-2013 Page 2 of 3

Full Pond/
Normal Water Leve
La ke
(At FuII Pond / Normal Water Level)
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FORM: SSGP 10-2013