20071514 Ver 1_More Info Received_20071029

Office Use Only: Form Version March OS
USACE Action ID No DWQ No. O 1 ' 1 S 1 ~
(1r any pamcutar uem is not appiicante co finis pro~ecr, please enter ivoi r~ppucaoie ur i~ir+ .~
I. Processing
~p~ID
1. Check all of the approval(s) requested for this project:
Section 404 Permit ^ Riparian or Watershed Buffer Rules
^ Section 10 Permit ^ Isolated Wetland Permit from DWQ
401 Water Quality Certification ^ Express 401 Water Quality Certification
2. Nationwide, Regional or General Permit Number(s) Requested:
3. If this notification is solely a courtesy copy because written approval for the 401 Certification
is not required, check here: ^ n(~(.; u,~ ~,,~ ~ 3~
4. If payment into the North Carolina Ecosystem Enhancement Program (NCEEP) is proposed
for mitigation of impacts, attach the acceptance letter from NCEEP, complete section VIII,
and check here: ^
S. If your project is located in any of North Carolina's twenty coastal counties (listed on page
4), and the project is within a North Carolina Division of Coastal Management Area of
Environmental Concern (see the top of page 2 for further details), check here: ^
II. Applicant Information
1. Owner/Applicant Information p
Name: ..3 ui~,n~ ~' QA :.l~iS~ a! ~ f~O ~ ~ ~°'"`
~r~
Mailing Address: / [~ 31 Tr ~ h ~.~wf~-k0l r S,.,P ~ d
Telephone Number: ~ oY) b2 `i - 3 ~ N ~
E-mail Address: S~.+~vs~.~e~~ aSb~-
Z
2. Agent/Consultant 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: ~ ~~ P L ~
Mailing Address:
---
(~.b one 4Rct-~v d
Telephone Number: q - 1 p _ ~ /
E-mail Address: /
f~CC~G~C~C p
~~
O C T 2 9 2007
~)EIVFt - WATER QUALITY
wE'TlMJD8 Af~D STORMW,RT~R BRANCH
~~
per:
OCT 2 4 2001
Page 5 of 12 NC DENR MRO
D~~O-~~r~o~~ ~Ja~er Protecti~;~