20071540 Ver 1_Shoreline Stabilization_20070911

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07-540
Office Use Only:
USAGE Action ID No.
No.
Form Version Aueust ?006
(If any particular item is not applicable to this project, please enter "Not Applicable" or "N/A".)
I. Applicant Information
Owner/Applicant Information
Name: ~, ~/Yi1' u ~v.v ~i4i2 iQ,,~ H
Mailing Address: 6 K9 ~oR,DAN it/A,RROrtJ
SEc n-~ ,v~c z~ r~~
Telephone Number: 4/ 9 ^ 96 S- ~6 S' Fax Number:
E-mail Address:
2. Agent/Consultant 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:
Company Affiliation:
Mailing Address:
}
P L~ . i e ~ ~. G°` ' Y ~ y i. ~ ~~ r y
Telephone Number: Fax Number: ~_ ~:~i
E-mail Address: ~~- ~ ~ ~ •~ ~~
II.
Project Information r~~r~r~ - .h~r~~~~:~ ~~~~ ,~~
~Y~~~.~.~i~ i ~:r;~n ri'i i'"1`?'.~S`~i:'~ r rti;< ~~~.I'~
Attach a vicinity map cleazly 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. Both the vicinity map and site plan must
include a scale and north arrow. The specific footprints of all buildings, impervious surfaces, or other
facilities must be included. If possible, the maps and plans should include the appropriate USGS
Topographic Quad Map and NRCS Soil Survey with the property boundaries outlined. Plan drawings,
or other maps may be included at the applicant's discretion, so long as the property is clearly defined.
For administrative and distribution purposes, the USAGE requires information to be submitted on sheets
no larger than 11 by 17-inch format; however, DWQ may accept paperwork of any size. DV`%Q prefers
full-size construction drawings rather than a sequential sheet version of the full-size plans. if full-size
plans are reduced to a small scale such that the final version is illegible, the applicant will be infornied
that the project has been placed on hold until decipherable maps are provided.
1. Location
County: ~IQAn~IC l .~ ~/ Nearest Town: ~ C( /V~/
Subdivision name (include phase/lot number): _L ~Kf /Qo ~/i4t E Low 9S - G
Site coordinates:
Decimal Degrees (6 digits minimum}: °N °W
Directions to site (include road numbers/names, landmarks, etc.): fjZu n^ 7~u N.v. __
~A~7 v.y ~AP~IS T _CNu ~. cN ~ ~ .. AT ENS Tu .2 N ~,rG~ v ~J
S(F c` ~D EN7~('A.vtE To Su /3 . ~y /yirc E ~v L Ef 7: La ?_
S.t>uATNJ oN__3A-uC StoE of L~-cE vnJ SA6x-~~,~E
Page 2 of 4

...
3. Property size (acres): ~. ~ 7 y i9r. RES i9~P?vlr 60 ~ x /Z o ~ 4r!
4. Name of nearest named receiving body of water(stream/river/lake): Li4KE' /ey~/Al c~
5. Describe the purpose of the proposed work: ~EPR.C~Q .1- ~,c`PL/4C F ~ ~S?2/~"
3~ ~ K M ~~ T~~ ,~.9-s C~c~A,/sc~ ~x.~rT~.-~ sc,~w~c ~ _
~i PPQd ~! 3 o y'c~S o~ l~ , Ex;s7f~ ?3d a~- ?~ o e'c wscc S ~~f-~i
/91 ,ZS Tn/ Sf},,..E Caul ?tvti•
6. List the type of equipment to be used to construct the project: /f~A/~~ ~ u L~
d~/L U V ~.¢e ~c~ ,
7. Type and amount of impact (including all back fill, excavation, riprap, retaining walls, other fill,
etc.) below the normal pool lake level in square feet or acres, and distance from shoreline:
~P~R vx. /' y~ FXn?~~ S~~EC~.vE
8. a. Type and amount of impact (including all clearing, back fill, excavation, riprap, retaining walls,
other fill, etc.) above the normal pool lake level and 50 feet land-ward in square feet or acres:
'may 3,~c~ F.~-c ~ ~S .vc~d c~ T ~4c~P~i-.v T 6~2~t1S Lo 7' .~ ~
b. Please describe the vegetation above the normal fool lake level and 50 feet land-ward to be
impacted number of trees for instance): /1/D 7'iPc'~FI ~r~i¢cTc~, o~/e-y ~SS
=.i~ v
~ Applicant/Agent's Signature Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)

Page 3 of 4

't
Lake ~At Full Pand)
Full Pand
Shoreline
dlatnlt ir"!i
t f3 r tip R
duck JU h x T R
rip raD
vftxlSDft
--
i InJnw fell
;pond v ft K 16D K
•ilnw~` full
Inunl
EXAMPLE
Please approximately sketch the following information on tli,~c pt~ln
(please provide dimensions for each item, such as 10 fl. x 1 ~:: ~ ~ f t l:
i} A11 proposed vegetation clearing provide dimensions)
~) Location of rip rap yr fll to be placed above the Fu1! Pon:, elevation
3} Location of rip rap or fill to be placed below the Full PWrr~l elevation
d} The location of any proposed structures such as buildinc,~.. retaining
walls, docks, etc.
3} The location of any excavation or dredging below the Fula Pond
elevation.
6) Location of construction access corridors.

~t
Lake ~Fulf Panda
Full Pared
Shoreline
.,
~~
e,~, aS'~`" ~o` ~'~
~~~ u~ ~
~~~ ,~
~~~~'f ~s
'~p~S
~x~ ~~~
~ _ ~v
~,~c,Pos~ 3~~~ N~
~~ ~~o~~
~i3 ~ ~K -+~-mss,
~LL
~'~'~ t
P~~
~~ ~ c~r7M
P~~ ~,~ R~p~~~T
~RTI ,
Please approximately sketch the fo[[o~~ing inforntiation on tktis plan
{please prol~ii~e dimensions fvr eac(i item, :such as '10 ft. z 100 ft}:
'f) All proposed vegetation clearing ~pravide dimensio~nsy
.~} Location of rip rap or fit to he plarecl ataove the foil Pond elevation
3} Location of rip rap sir fll Co foe placed belovr the Pull Pond elevation
~~ The location of a.n.y praRosed structures such as boildings, retaining
vral:f's= docks, etc.
5} The loca>iigr~ 4i anl~ Excavation or dreclgi~~g lye[o~v the Full Pand
elevation.
6) Location of consEruction access corridors.
~c /~'0cfo A~
6~s R~iANfi
~~ s~uR~y
~F~ ~~

N Disclaimier: Tnis map is prepared for the invemory of real property
found within the jurisdiction, and is compiled from recorded deeds,
plats, and other public records and data. Users of this map are hereb7
notified that the aforememioned public primary infortna[ion informatioi
W ~ sources should be consulted for vedfiCation of the inionnation
comained on the map. The county and mapping company assume rw
S legal responsibility for the information contained on this map.
1 in. = 58.6 feet
4
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