20150108 Ver 1_Application_20150126

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The following is an abbreviated al
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AO�� =forna =fog tboseappIying for a 401 mater Quality
Certification to impact FER C (Federal Energy Reg to Co ssgon) regulated Sake shore or
bottom -ender the U.S. Army Corps ®f engineers P ernlit 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 �aaagity of $2, 0.00
for impacts to lake bottom of less than 1 acre and $590.00 for impacts to lake bottom of greater or
eq¢aa8 t ®1 acre.
Applications should be sei?t to: � � t
Division on Warer Quality 401 Overssig -ht/�
L1650 'Mail Service Center � impress Review �ermittin JAN 2 6
2015
Raleigh, NBC 29699 -1650
DENR - WgrER RESOURCES
Applicmt .I<nformation 401 & BUFFER PERMITTING
1 • Owner /Applicant information
Name- V
Mailing, A ddress- P �t t
Telephone Number:
Fax Number-
E-mail Address
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: � t= " I, "
Company Affibation.
Mailing Address:
Telephone Number:
E -mail Address
H. Project wormation
Fax Number.
C
Attach a vicinity map clearly showing the location of the property with respect to local landmark s such
as towns, riders, 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
hand sketch of your project. Also, see the example below for guidance. Both the viciin ma a
plan must include a scale and north arrow The footprints of all buildings, impervious surfaces, site
facilities must be included r other

1. Location
County: bA-Ct +.,.1)DCI Nearest Town:
Subdivision name or site address (include phase/lot number)- �S9
Directions to site please include road numbers, landmarks, etc. (This is not necessary i an adequate
ade
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vicinity map is included): K) C 4L, -k I Vsp �r r
C1 I- N A
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2. Describe the existing land ''uttse or condition of the site at the time of this application
3. Property size (acres). o yy
4 Nearest body of water (stream/nver /sound/ocean/lake):
5 Describe the purpose of the proposed work- D �&
6. List the type of equipment to be used to construct the project
CC r) e A-v-Y'
Amount of impact (including all excavation, backfill, rip rap, retaining walls, etc) below the
normal pool lake level in square feet or acres QC_� J
8.a. Amount of impact (including all clearing, back fill, excavation, np rap, retaining walls, etc.)
above the normal pool lake level and 50 feet land -ward in square feet or acres.
8.b. Please describe vegetation above the normal pool lake level and 50 feet landward to be impacted
(number of trees for instance)-
Applicant/Agent's Signature a
Date
(Agent's signature is valid only if an authorization letter from the applicant is provided)

CATAWBA Geospatial
_.__. Information Services
Real Estate Search
N
W + E
S
Parcel: 462802661530, 9594 RIVIERA DR SHERRILLS FORD, 28673
Owners: BARTELS DAVID DEAN,
Owner Address: 9594 RIVIERA DR
Values - Building(s): $307,700, Land: $230,900, Total. $538,600
1 in =150ft
This maplreport product was prepared from the Catawba County, NC Geospatial Information Services. Catawba County has made substantial efforts
to ensure the accuracy of location and labeling information contained on this map or data on this report. Catawba County promotes and recommends
the independent verification of any data contained on this map /report product by the user. The County of Catawba, its employees, agents, and
personnel, disclaim, and shall not be held liable for any and all damages, loss or liability, whether direct, indirect or consequential which arises or may
arise from this map /report product or the use thereof by any person or entity.
Copyright 2014 Catawba County NC
01/22/2015