20150136 Ver 1_Shoreline Stabilization_20150202

The following is an abbreviated application form for those applying for a 401 Water Qtaality
Certification to impact FERC (Federal Energy Regulatory Commission) regulated take shove or
bottom under the U.S. Army Corps of Engineers Permit GP30. This Application cannot be used
for wetland or stream impacts. Please provide five (5) collies of dais application and supporting
information as well as a non - refundable application fee to the Division of Water duality of ��d0.00
for impacts to take bottom of less than 1 acre and $570.00 for impacts to take bottom of greater or
equal to � acre.
Applications should be se?� .r 9 �
t to. --�„
Division of Water -- FEB 0 2
1 �- a Quality 401 Oversight/Express Review Permitting 2015
�501Ta3L Service Center
Raleigh, NC 27699 -1650 DENR - WATER RESOI r>uE,
1. Applicant Information
2 0 1 5 0 1 3 6
1.
Owner/Applicant information (
Name: � u► A > Y y- L5
Mailing Address:
Telephone Number: � �,� � � ; —� 1 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 authonty for the owner /applicant.)
Name: (-Is P,A n g A A n .t ---
Company Affiliation-
Mailing Address:
Telephone Number:
E-mail Address:
11- Project I_infornaation
AJI
Fax Number:
r VLA-
Attach a vicinity cnaio 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. Bth the plan must include a scale and north arrow. The footprints of all buildings, im rvious suulfaces orr other
facilities must be included.

1. Location
County: ( l� we--t Nearest Town:
Subdivision name or site address (include phase/lot number):_
Directions to site please include road numbers, landmarks, etc. (This is not necessary if an adeq ate 9
vicinity map is included):
2. Describe the existing land use or condition of the site at the time of this application:
3. Property size (acres): g ;�
4. Nearest body of water (stream/river /sound /ocean/lake):
5. Describe the purpose of the proposed work:
6. List the type of equipment to be used to construct the project:
7. Amount of impact (including all excavation, backfill, rip rap, retaining walls, etc.) below the
normal pool lake level in square feet or acres:
8.a. Amount of impact (including all clearing, back fill, excavation, rip 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): LAS S bv� 11,
J
Applicant/Agent's Signature _ I
Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)

Print - Maps
1> bing Maps
A Mooresville, NC
B 6342 Mountainside Dr, Hickory, NC 28601
Route 54.0 mi, 56 min
Page 1 of 1
My Notes
On the go? Use m.bing.com to find maps,
dsrecftons, businesses, and more
A
Mooresville, NC
A —B: 54.0 mi
56 min
1.
Depart W McLelland Ave toward S Academy St
0.9 mi
2.
Bear left onto NC -150
1.8 mi
3
Take ramp right for 1 -77 North toward Statesville
Pass Days Inn on the right in 0 1 mi
15.3 mi
13 min
4.
At exit 51 B, take ramp right for 1-40 West toward Hickory
29.1 mi
25 min
321 5.
At exit 12313-A, take ramp right for US -321 North toward Lenoir /
Hickory
Pass Jack ►n the Box on the left in 2 8 mi
4.7 mi
to 6.
Turn right onto Grace Chapel Rd
1.5 mi
7
Turn right onto Mountainside Dr
0.7 mi
B 8
Arrive at 6342 Mountainside Dr, Hickory, NC 28601
The last intersection is Longview Ln
These directions are subject to the Microsoft® Service Agreement and for informational purposes only No guarantee is made regarding their completeness or accuracy
Construction protects traffic, or other events may cause actual conditions to differ from these results Map and traffic data © 2015 NAVTEQTM
http: / /www.bing.comlmapslprint.aspx ?mkt= en- us &z= 10 &s =r &cp= 35.697142, - 81.098632... 1/28/2015

rrmung: Layout rage Page 1 of 1
This map is prepared for the inventor) of read property found within Ibis jurisdiction, and is compiled from recorded deeds, plats, and other public records and data Users of this map are hereby noticed that the
aforementioned public prinnan infomtaliom sources should be consulted for yenficalion of the information contained on this mop. Caldwell County and its mapping and software contractors assume no legal responstbdity
for die information contained on this map or in this website. This map and information are NOT of land s, quality and are NOT suitable for such use.
http: / /gis.caldwellcountync- org/maps /layout.aspx 1/28/2015

rnMing: Layout Page Page 1 of 1
This map is prepared for the im em— of real property found within this juisdictiM Mid is compiled from recorded deeds, plats, and other public records and data Users of this map are hereby notified that the
aforementioned public priman. information solaces should be consulted for yenfication of the information contained on this map. Caldwdl County and its mapping and soflssare contractors assume no legal responsibility,
for the information contained on this map or in this wetisite. This map and information are NOT of land survey quality and are NOT suitable for such use.
http:// gis. caldwellcountync .org/mapsAayout.aspx 1/28/2015

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