20141228 Ver 1_Shoreline Stabilization_20141203

State of North Carolina
Shoreline Stabilization Application Form 2 0 1 4 1 2 2 8
Three copies of the application (including attachments) and the application fee should be sent
to:
Division of Water Resources
401 & Buffer Permitting Unit
1617 Mail Service Center
Raleigh, NC 27699 -1617
I. Applicant Information [15A NCAC 02H 0502(a)]
1 Owner Information
Name David Garrett
Mailing Address 978 Wessington Manor Lane
Fort Mill, SC 29715
2'r')
Telephone Number. 704 - 301 -7538 Fax Number.
E -mail Address: gar5360 @aim.com
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 mil / Portals /59 /docs /regulatory /regdocs /Permits /SAMPLE AGENT AUTH
ORIZATION FORM pd f) must be attached if the Agent has signed this application form
Name
Company Affiliation-
Mailing Address:
Telephone Number: 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 3

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. Jackson Nearest Town- Glenville, NC
Subdivision name or site address (include phase /lot number): Lakeside Village, Lot I
Directions to site - please include road names and numbers, landmarks, etc Take Hwy 107
N out of Cashiers; Turn left on Lakeside Circle (across from Happ's Restaurant); Follow hard
road until it turns to dirt /gravel Stay on dirt /gravel road, Take 2 "d left on to Undala Trail;
Follow it up the hill: When road splits — stay left; follow it down then up the hill; at the T in
the road, turn left — that is the start of'rour driveway
Latitude (in decimal degrees) �5a (' q 4 q 4 Longitude (decimal degrees) 83. 14 3(.0 I
5 Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): residential- single family
6 Property size (acres): i . // R c;--e S
7 Lake/ river/ ocean adjacent to property: Lake Glenville
8 Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary):
9 Will work be conducted from land? ❑ From water? [�
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.
2-v0 5 Qe
11 Total amount of disturbance (including all clearing, back fill, excavation, rip rap, retaining
walls, etc ) above the normal pool lake level/ Normal Water Level and 50 feet land -ward in
square feet or acres /yo 5¢F
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)- _ � AC_r 104
Owner /Agent's Signa e* [15A NCAC 02H .0502(f)l
/ /- 2 © -C
Date
tAgent's signature Is valid only if an authorization letter from the owner is provided
FORM SSGP 10 -2013 Page 2 of 3

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Normal,
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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NOTES
LOT F
LAKESIDE VILLAGE
` I PRIVATE ) Teac wa
JO ROAD R/f!t Lm-
LOT H
LAKESIDE VILLAGE
0 NO NORTH CAROLINA CONTROL SURVEY LOCATED WITHIN 2,000 FEET
2) ME1001AN -- EXISTING PLAT OF LAKESIDE VILLAGE SUBDIVISION
3) THE PROPERTY SHOWN HEREON IS NOT LOCATED WITHIN ANY DESIGNATED
FLOOD HAZARD AREA
4) ALL ROADS SHOWN ON THIS PLAT ARE PRIVATE AND ARE NOT DEDICATED
TO PUBLIC USE
SURVEY FOR:
BENJAMIN P. POWELL and JEANNE F. POWELL
REY7S/0/Y5 PLAT PREPARED FOR
LOT 2
_ LAKESIDE VILLAGE
TIMNSHIP.• K&ABMG COUNTY JACKSON
0 50 STATE = NORTH CAROLINA
SCALE ZONE: TAX MAP PARCEL:
L. STEPHEN ROSTER, LAND SWV£YOR
P,D.80W AO6i HIGHLANDS, NORTH CAROLOVA
VFPME /MVW ,1ESIDENCE
IIU+J 9"-&*" fM4; T4 4Wl
DATE' f -29 -1991 SURVEYED BY L.SF. FIELD BOOK
F -11
SCALE. T= So- ZRA** BY= LO.S. LIRAWING M7.
ChECKED $ CLOSURE BY: C. S. F. F- 11-441 [A)

AV 71-4,
1
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. Nov 24, 2014

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