20141163 Ver 1_Shoreline Stabilization_20141106

2 State of North Carolina
A 0 1 4 1 1 6 Department of Environment and Natural Resources
Division of Water Resources
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15A NCAC 02H.0500 — Water Quali rt'f* Lion, Shoreline Stabilization
Division of Water Resources 6�r Q.�^�„D
(r=� .M: SSGP 10 -2013
Shoreline Stabilization Application Form
Three copies of the application (including attachments) and the
to:
Division of Water Resources
401 & Buffer Permitting Unit
1617 Mail Service Center
Raleigh, NC 27699 -1617
1. Applicant Information [15A NCAC 02H .0502(a)]
1. Owner Information
Name- V\ic 1' td
Mailing Address: 191. -5 9L
Telephone Number. N60 115p- Y>g5Y- Fax Number:
E -mail Address 1 i�✓�� �' r ✓,� �1��� =5*'/ - !Lo"
2. Agent/ Contact Person Information
A signed and dated copy of the Agent Authorization letter (a form can be downloaded here:
http / /www saw usace army milZPortals /59/­docs /regulatory /reRdocs /Permits /SAMPLE AGENT AUTH
ORIZATION FORM pd f) must be attached if the Agent has signed this application form.
Name: A u- `l 13, NIG_� �- A'r - -e/
Company Affiliation:
Mailing Address. <�- c�fY� -�� ✓�>'
Telephone Number: 5'4-/ YY) 'F�5 q Fax Number:
E -mail Address:
Person to receive the Certification Approval:
11. Project Information [15A NCAC 02H .0502(a) & (b)]
1. Attach a vicinity map (i.e. street map) clearly showing the location of the property with
respect to local landmarks such as towns, rivers, and roads.
2 Provide a detailed site plan showing property boundaries and proposed locations of
vegetation clearing, structures (buildings, retaining walls, docks, impervious surfaces,
FORM: SSGP 10 -2013 Page 1 of 4

etc.), rip rap, excavation or dredging below Full Pond/ Normal Water Level elevations,
and construction access corridors. You may use the diagram provided at the end of this
application form.
3. Attach a photograph of the shoreline/ buffer proposed to be stabilized. (Include a scale
of some sort- a yard stick, shovel handle, etc.)
4. Location of the property (where work is to be conducted)
County: r t Nearest Town: err WAO/
Subdivision name or site address (include phase /lot number): 4, }--e
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Directions to site - please include road names and numbers, landmarks, etc. 6
Latitude (in decimal degrees) 3''r l % � LOngltude (decimal degrees) 3 Al 7y,57
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): A65 AeloJ41/
6. Property size (acres):
7. Lake/ river/ ocean adjacent to property: 1-1-4C=6
8. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): iDI a ✓ - b i t n �, nom_
9. Will work be conducted from land? ❑ From water? (k
10. Total amount of disturbance (including all excavation, backfill, rip rap, retaining walls, etc.)
below the normal pool lake level/ Normal Water Level in square feet or acres-
PO #%
11. Total amount of disturbance (including all clearing, back fill, excavation, rip rap, retaining
wails, etc.) above the normal pool lake level/ Normal Water Level and 50 feet land -ward in
square feet or acres: F.�2 j 6?
12 Please describe the vegetation above the normal pool lake level/ Normal Water Level and
50 feet landward to be impacted (number of trees, for instance). t�V- - 1 1 1 f'
r /Agent's Signature* [15A NCAC 02H .0502(f)]
Date
Agent's signature is vohd only if an authorization letter from the owner is provided
FORM SSGP 10 -2013 Page 2 of 3
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Please approximately sketch the following information on this plan (provide dimensions for each
item, such as 10 ft x 100 ft) *•
1. All proposed vegetation clearing
2. Location of rip rap or fill to be placed above the Full Pond/ Normal Water Level elevation
3. Location of rip rap or fill to be placed below the Full Pond/ Normal Water Level elevation
4. Location of any proposed structures such as buildings, retaining walls, docks, etc.
5. Location of any excavation or dredging below the Full Pond/ Normal Water Level elevation
6. Location of construction access corridors
FORM- SSGP 10 -2013 Page 3 of 3

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This map is prepared for inventory of real property within Jackson County. It is compiled from recorded deeds, plats, and public data records.
Users of this map are hereby notified that the aforementioned public information sources should be consulted for verification. Jackson County
any County representative assumes no legal responsibility for the contents of this map. Printed :Oct 24, 2014

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CONCRETE
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V LOT 10
TOPOGRAPHIC SURVEY 0 20' 40' 60' 80, 100,
E
EAL
DATE., JULY 17 1992 278
PREPARED BY
SCOTT M. SYLVESTER, RLS, PA
SURVEYING PLANNING
P.O. BOX 1506- - CHESTNUT SQUARE TEL [phone]
CASHIERS, NORTH CAROLINA 28717 FAX [phone]
DRAWING NO. 2491