L48 ID 20230995 .pdf

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S. Descnbe the eNisting land use or condition of the ssite at the time of this application (residential,
undeveloped. etc.): — ^' ! `�
o. Describe proposed work, linclude discussion as to how hardening of shoreline has been avoided, 4r
why it is necessary):
7. Will work be conducted from land? Ca_ From water?
8, Total amount of impacts below the normal pool lake level / Normal Water Level
Permanent 'mpacts (including all exccavation, ba fill, rip rap, retaining walls, etc.) in square feet:
Temporary impacts in square feet:
9. Total amount of impacts above the normal pool lake level / Normal Water Level and 50 feet land-
wa rd
Perm anent„impacts (including back fill, excavation, rip rap, retaining walls, etc.) in square feet:
Temporary impacts (temporary clearing, construction corridor) in square feet:
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10. Please describe the vegetation above the normal pool lake level/ Normal Water Level and 50 feet
landward to be impacted (number of trees, for instance): O ^/4i 3 S
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11. Signature
By signing below, I, as the project proponent, certify to the following:
• The project proponent hereby certifies that all information contained herein is true, accurate,
and complete to the best of my knowledge and belief
• The project propon hereby requests that the certifying authority review and take action on
this CWA 401 c ific ion request within the applicable reasonable period of time
00.
Own Agent's Signature' [15A NCAC 02H .0502 f ]
`Agent's signature is valid only if an authorization letter from the owner is provided.
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12. Please approximately sketch the following information on this plan and provide dimensions for
each item:
a. All proposed vegetation clearing
b. Location of rip rap or fill to be placed above the Full Pond/ Normal Water Level elevation
c. Location of rip rap or fill to be placed below the Full Pond/ Normal Water Level elevation
d. Location of any proposed structures such as buildings, retaining walls, docks, etc.
e. Location of any excavation or dredging below the Full Pond/ Normal Water Level elevation
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