20150383 Ver 1_Shoreline Stabilization_20150422

PAD 20�
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 five (5) copies of this application and supporting
information as well as a non - refundable application fee to the Division of Water Quality of $240.00
for impacts to lake bottom of less than 1 acre and $570.00 for impacts to lake bottom of greater or
equal to 1 acre.
Applications should be sent to:
Division of Water Quality 401 Oversight/Express Review Permitting
1650 Mail Service Center
__________�_
� U v
Raleigh, NC 27699 -1650
I. Applicant Information
APR 2 2 2015
1. Owner /Applicant Information
DENR - WATER RESOURCE
401 &BUFFER PERMITTING
Name: C� M P P-(^ So (�
Mailing Address 2; 59 C-r o r A o r� S�
lerfe.I1 0C_ a6(0��
Telephone Number. 90 ' a q (e - -% 9 9 ]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: C 1 (!� 67-i'ct c r1 G
Company Affiliation
Mailing Address. -box 31 te- f oo
Telephone Number :1 c3 -9 U2- (3 S Fax Number
E -mail Address
H. Project Information
Attach a vicinity map 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 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
County 01 0.c Nearest Town. �
Subdivision name or site address (include phase/lot number) 0+4� 0oAs -i _
�-�e
Directions to site please include road numbers, landmar s, etc. Thus is not necessary if an aderqul ate
vicinity map is included) a o dt
2 Describe the existing land use or condition of the site at the time of this application
3. Property size (acres)- � 'k 1
4 Nearest body of water (stream/river /sound /ocean/lake) O r (lA an
5. Describe the purpose of the proposed work. SAn h Z2 Kcxf-p I, s_
M
List the type of equipment to be used to construct the project: bnh(�1 f''l I t _e_ (_C
7 Amount of impact (including all excavation, backfill, rip rap, retaining walls, etc ) below the
normal pool lake level in square feet or acres 3c)1 Sum
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.
�(� S4
8b Please describe vegetation above the normal pool lake level and 50 feet landward to be impacted
(number of trees for instance) ­91 S s ' L t� U1 c (mot
1 -
Applicant/Agent's Signature Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)

Print - Maps
LV bing Maps
A Mooresville, NC
B 3859 Gordon St, Terrell, NC 28682
Route 10.2 mi, 20 min
Page 1 of 1
My Notes
On the go7 Use m.bing com to rind maps
directions businesses and more
A
Mooresville, NC
A —B: 10.2 mi
20 min
1
Depart W McLelland Ave toward S Academy St
0 9 mi
2
Bear left onto NC -150
Pass McDonald's in 2 2 mi
7 7 mi
3
Turn back on Greenwood Rd
0 8 mi
4
Road name changes to Gordon St
0 7 mi
B 5
Arrive at 3859 Gordon St, Terrell, NC 28682
The last Intersection is Kingfisher 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 NAVTEQ T'"
http. / /www bing. com /mapslpnnt.aspx ?mkt= en- us &z= 12 &s =r &cp= 35.594334, -80 886324.. 4/14/2015

CATAWBA Geospatial
Information Services
Real Estate Search
N
w E
5
Parcel: 462701063102, 3859 GORDON ST TERRELL, 28682
Owners: PETERSON THOMAS L, PETERSON REBECCA J
Owner Address: 3859 GORDON ST
Values - Building(s): $383,500, Land: $271,300, Total: $654,800
1 in =300ft
This map /report 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
04/14/2015