20140939 Ver 1_Shoreline Stabilization_20140828

10140-939
The following is an abbreviated application form for those applying for a`:�IUi fL'��ter. „
Ce "tie" tion to impact F)E;RC (Federal Energy Regulatory Commission) regulated laQ shore or
bottom under the U.S. Army Corps of Engineers Permit GP30. This Application cannot be used
for wetland or stream impacts. Plea�sc'pi <i� iiie five„ (S) copies,of this, applicatioi
inform��tii►rr,as tivell as u,noil'- refundable applicativa %_fee to 't. le I Visirin 'of �4'ater, fluailio. pf,$2aU,U0
for imliacts to'take Bottum aifless ttiaml'iicre and $570.00 for impacts to lake bottom of greater or
equal to i acre. -
#'Applications should be sent to:
l )ivi §iori= ciCVViit�;n(�uiilitj- 401,_ C) izeisigtil /Isxpress- ItevlE'11;Ycr`mittin :
4fi5Q N•lail, Service Center`
Ralcii li NC 276y9= I,CSO,
I.
I.
2.
Applicant Information
Owner /Applicant Information
Name:
Mailing
c
w, 6292014
Telephone Number:
E -mail Address:
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:
Company Affiliation:
Mailing Address:
Telephone Number: Fax Number:
E -mail Address:
II. Project Information
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. Bolh 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.

Davidson County Map Output Page Page I of 2
Davidson County GIS
http://webgls.co.davidson.nc-us/website/davidsongis/printpage.aspx 8/22/2014
1�e
t
Parcel Number
06035DOOL0019
Land Units:
LT
Pin Id:
67110-04-50-8824
Deed Book:
1743 Pg: 1143
F B LEE DEVELOPMENT CO INC
Owner:
1318 LEE ROAD
Deed Date:
1 1.01/2006
THOMASVILLE'NTC 27360-9434
Property Address:
2340 RIVFRVILW RD
Account Number:
9082682
Township:
06
Exempt Code:
Building ft
SO Other Building Value:
so
Land Value:
5125.000 Market Value:
S 125,000
http://webgls.co.davidson.nc-us/website/davidsongis/printpage.aspx 8/22/2014

Davidson County Map Output Page
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Page 1 of 2
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tioo M70 �,
Parcel Number :
06035DOOLO019
Land Units:
LT
Pin ld:
6710 -04 -50 -8824
Deed Book:
1743 Pg:1143
E B LEE DEVELOPMENT CO INC
Owner :
1318 LEE ROAD
Deed Date:
1 1/01 %2006
THOMASVILLE NC 27360 -9434
Property Address:
2340 RIVERVIE,W RD
Account Number:
9082682
Township:
06 \_
L
Exempt Code:
Building Value:
SO Other Building Value:
SO
Land Value:
$125.000 Market Value:
5125.000
http: // webgis. co. davidson. nc. us / website /davidsongis /printpage.aspx 8/22/2014