SSGP04-2022_ShorelineForm_04202022 (2).pdf

A. Applicant Information [15A NCAC 02H .0502(a)]
1. Owner Information
Name: Connie Yoe
Mailing Address: 936 Hawk Ridge Dr. Mill Spring NC 28756
Telephone Number:
E-mail Address:
1 [phone] Fax Number:
[e-mail]
2. Agent/ Contact Person Information
A signed and dated copy of the Agent Authorization letter must be attached if the Agent has signed
this application form. (A form can be downloaded here:
htto://www.saw.usace.armv.mil/Portals/59/docs/reizulatorv/reL-docs/Permits/SAMPLE AGENT AUTH
ORIZATION FORM.pdf)
Name: Warren Eadus
Company Affiliation: Quible & Associates, P.C.
Mailing Address: 90 Church Street
Black Mountain, NC 28711
Telephone Number: [phone] Fax Number:
E-mail Address: [e-mail]
B. Project Information [15A NCAC 02H .0502(a) & (b
1. Attach a vicinity map (i.e. street map) clearly showing the location of the property with respect
to local landmarks such as towns, rivers, and roads.
2. Provide a detailed site plan showing property boundaries and proposed locations of vegetation
clearing, buildings, retaining walls, docks, impervious surfaces, rip rap, excavation or dredging
below Full Pond/ Normal Water Level elevations, and construction access corridors. You may use
the diagram provided at the end of this application form.
3. Attach a photograph of the shoreline/ buffer proposed to be stabilized. (Include a scale of some
sort- a yard stick, shovel handle, etc.)
4. Location of the property (where work is to be conducted)
County: Polk Nearest Town: Mill Spring
Lake/ river/ ocean adjacent to property: Lake Adger
Property size (acres): 1.02
Subdivision name or site address (include phase/lot number): Lake Adger
Directions to site - please include road names and numbers, landmarks, etc.: From Hwy 9 S, turn
west onto Garrett Rd. Proceed 0.32 miles and turn right (north) onto Green Hills Rd. Follow Green
Hills Rd. for 0.45 miles and turn right onto Hawk Ridge Dr. Follow Hawk Ridge Drive to the end
rox..93 miles) and drivewav is off of cul-de-sac (936 Hawk Ridge Rd.
D E Q�� North Carolina Department of Environmental Quality I Division of Water Resources
512 North Salisbury Street 1 1617 Mail Service Center I Raleigh, North Carolina 27699-1617
NORT CAROLINA -
oeperoeemofemroeel lrmMyy /� 919.707.9000