HomeMy WebLinkAbout20140864 Ver 1_Application_201408082 0 1 4 0 8 6 4
The following is an abbreviated application form for those applying fore Pq
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 five (5) 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 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
1650 Mail Service Center p �a _
Raleigh, NC 27699 -1650 L� n
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1. Applicant Information AUG 1 12014
1. Owner /Applicant Information
Name: �, �r f f WVATgR ouar
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Mailing Address:
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Telephone Number:
-mail Address:
Fax Number ---
2. Agent Information (A signed and dated copy of the Agent Authorization letter
must be attached
if the Agent has signatory authority for the owner /applicant.)
Name: +
Affiliation::
> Aa'e— I� C-i A �
Mailing Address:
Telephone Number: -L/,L/6- 7 old Fax Number.
E -mail Address: (I
II. Project Information
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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.
1 Location
County: Nearest Town-
Subdivision name or- site address (include phase /lot number).
ED,,Z 360, iD, NC
Directions to site please include road numbers, landmarks, etc (This is not
necessary if an adequate
vicinity map is included)- r� A
S' c � c ad- ii? S,, l A Ji Sn_ r` k r c -h � S fi S )r M E
2. Describe the existing land ,use or condition of the site at the time of this
application- 6 00 C
3 Property size (acres) -
0e/ /d
4. Nearest body of water (stream /river /sound /ocean /lake):
Z— -I ke 9, t- k.x _l
5 Describe the purpose of the proposed work
6. List the type of equipment to be used to construct the project
smL,It P) c6l ��. isk:�s+ -ee"—
7 Amount of impact (including all excavation, backfill, rip rap, retaining walls,
etc.) below the
normal pool lake level in square feet or acres
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
8 b. Please describe vegetation above the normal pool lake level and 50 feet
landward to be impacted (number of trees for instance):
4n j3 to
Applicant/Agent's Signature Date
(Agent's signature is valid only if an authorization letter from the applicant is
provided )