20071694 Ver 1_More Info Received_20071012

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The following is an abbreviated application form for those applying.for a 401 Water
Quality Certification to impact FERC (Federal Energy Regulatory Commission)
regulated lake shore. or bottom under the U.S. Army Corps of Engineers Permit
GP30. This Application cannot be used for wetland or stream impacts. Please
provide seven ('~ copies of this application and supporting information as well as a
non-refundable application fee to the nivision of 'l~Vater Quality of $200,00 for
impacts of to lake bottom of less than 1 acre and $475.00 for impacts t a lom
of greater or equal to 1 acre. ~ p
Applications should be sent to:
nivision of'1~Vater Quality Wetlands Unit
1650 Mail Service Center
Raleigh, NC 27699-1650
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DENR -WATER AUALITY
VVt'TLANDS AI~lD STORMIMAT6R BR~H
I. Applicant Information
1. Owner/Applicant l:nformation
Name: ~. ~~~nzL~ ~I(.QS (f~~~~~ ~~c~ck,~ss~
Mailing Address: Cc.C' leVlr.~ -
Telephone Number; ') Fax Number: 7;7t
E-mail Address: ~l_~S' ~ 'TILP~17"r'~!1'sGt_. ~'.oM_
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:
Company Affiliation:
Mailing Address:
Telephone Number:,
E--nail Address:
II. project Iufor-natiou
Fax Number:
Attach a vicinity map clearly showing the location of the property with respect to
local landrraarks such as towns, rivers, and roads. Also provide a detailed site
plan shoaling property boundaries and development plans in relation to
surrounding properties. You may use the diagram below to make a hand sketch of

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your project. Also, see the example below for guidance. Both 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.
1. Location r~j
County: ~ /~'c...cS01`1 Nearest Town; ILi: X v h u r' ~~
Subdivision name or site address (include phase/lot numbe,~); ~ ~; _~ .~
Directions to site please .include road numbers, landmarks, etc, (This is not
necessary if an adequate 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): f! ~ G~~.-~~%~
4. Nearest body of water (stream/river/sound/ocean/lake): ~-'~'C~ ~~.CL
5, Desc~be the purpose of the proposed work: .
..
its .~ -:, y~~_ ~ ,/~G ~ ~,
6. List the type of equipment to be used to construct the ~oject:
d ft ~
7'. Amount of impact (including all excavation, baekfill, rip rap, retaining walls,
etc.) be]oW the normal pool lake level in square feet or acres:
G~ 1 r ti~ t~l ~.t'-1'"
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: ; ,,
the applicant is provided,)
b. Please describe vegetation above the not~nal pool lakc Icvcl and 50 feet land-
ward to be impacted (number of trees for instance): -