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from: TAMARA KAGEIR 4'
Subject; I:ary^er pcs pool
DaW Ju^e 8, 20n at 3 43 PM
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AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIMON:
LOT NO. `514 Z- PLAN NO. l" PARCEL ID. '4y �'� _ �t `�_ • _-74'S7- am
STRFEP ADDRESS _ !A f Lk rs to
Please print:
Property Owner: MAnt- k. � CjA-" IN AC, A4 LE
Property Owner: S Ays, c _
The undersigned, registered property ovmers & the above noted property, do hereby audmxue
at
( nt) (Name of consu"g firm)
to act on nay behalf and take all actions necessary for the processing, issuance and acceptance of
this permit or cettificadon and any and all standard and special conditions attached.
PrrhpA!rty [iwners Address (if different than property above):
Te6ephone: 7<>1 - S- S
We hereby m"y the above information s7ubm�tted in this application is true and accurate to the
best of our knowledge.
1
Au a _ Authorized Signature
Oahe: ?!�.3 _ Date:
CATAWBA RIPARIAN BUFFER NOTIFICATION FORM
Protect Name/address: WA-( Illr�. Qr
- -[� ►V ra �+ ounty:
Owner- _M_ L�1All N
Print 5ignatu re
Cor:tractor/agent: Alilf� d
Print Siena
:r,a approval is for the purpose and design described in your application. Impacts not indicated In the
application is a violation of the Buffer Rule. Site specific work should be provided in the application. I;SA NCAC
C2 , .0506 a,,_ _S46 NCAC 028.0243(8))
Trees are not allowed to be removed from Zone 1 of the Buffer (within 30 ft of the ft:ll pond elevation), unless
awGved. c,.ceptron. chase trees that are severely undermined along the immediate shoreline can be removed,
-Aii,imai shr-;jing aA.: siup+rkg along the immediate shoreline is allowed, 115A NCAC 02B .0243(6)]
Benching, grading in the buffer is not allowed, Excessive disturbance of ground cover, [1SA NCAC 02B .0243 (6)1
baacr►es, int;eryio:js patios, impervious walkways, etc. are not allowed in the buffer unless specifically approved
Lv V'A Divis,,3n. Tae;e are limitation an sire for decks. 115A NCAC 026 ,0243(4) and (6)]
'.Volk to be cUnducted from land must indicate an access and indicate any trees that are to be removed. The
work corridor should be described, The approved access corridor snail be restored_ Staging, spoil, construction
roa:er,ai must Ge ,�uuide rile buffer. 115A NCAC 02H .OS02 and 15A NCAC 028.0243 (4), (6), (8)j
Stomtwatef ZW',not ne piped or channeled For direct discharge to the lake. All constructed stormwater
ui'cha:ges Must ►A a: the natural elevation and discharged prior to entering the buffer directed as diffuse or
$,'feet flow at nor. -erosive veloclries to the lake. 11.5A NCAC 02B .0243(5), (6)j
Aakn***dgement of Nod;Bration
.�CaCi --' �'►� hereby state that I have been informed of the Catawba
Hi"ridn gu: �E.-;.,:c. _IV A0rk cor,CUCted in the buffer, not speci&aIIV stated in the application and approved
b•y `re Divfswn rf Wa:er Resources (DWR), is a violation and subject to enforcement. D.L a diligence w.11 be
;Uth -(:at ::,e tJ; -.: ,-tion will be built within substantial compliance and intent of the 401 Water
❑uatity Certification and Buffer Rules, the approved plan(s) and specification(s), and other supporting
r-�!terlats.
lgstatt.rc;vwncry Dates -71r 3��3