20231375 Ver 1_Site Plan_20231006

Proposed
(Plan View)
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Plan View MCA M P E

Proposed
(Side View)
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Duke Energy Lake Services
Guidance for Completing an Excavation Permit Application
Note: If you are proposing excavation in association with the permitting of a new
or expanded facility under the Marina or Conveyance Programs, you do not need
to complete this application. Instead, you should incorporate the excavation
request into the permit application for the marina/conveyance using the
appropriate application.
Step 1: Contact Duke Energy Lake Services
Complete "Part I" of the application and develop a drawing of the proposed excavation area.
Contact Duke Energy Lake Services to schedule a site visit. Lake Services will conduct a site
visit to determine if Duke Energy will accept an excavation permit application for the proposed
work. If the Lake Services representative determines the application process may proceed,
he/she will initial Part I of the application.
Step 2: Draft Application Development
Complete Parts II-III.A-G and Part V of the Excavation Permit Application.
Step 3: Agency Consultation
Send the draft application developed during Step 2 to the agencies for review and comment on
the proposed activity. Refer to the Agency / Organization List available from Duke Energy to
determine which federal, state, regional, and local agencies and organizations require
consultation or review.
Note. Duke Energy reserves the right to require consultation with additional organizations
beyond those included in the Agency / Organization List.
Each agency / organization must be provided at least 30 days prior notification. Evidence must
be provided (e.g., response letter or Certified Mail receipt) in the complete application to show
each agency / organization was given the opportunity to review the proposal.
Consultation letters must be dated within the two years preceding Duke Energy's receipt of the
application. All permits must be valid at time of application and have a term longer than the
projected schedule for completing the permitted project.
What to Expect During Agency Review and Comment:
• You will typically receive a letter from each agency / organization either documenting its
concurrence with your proposal, requiring additional information, recommending
modifications, or offering no comment. You must address each agency's / organization's
comments with a follow-up letter and in your final application as described in part IV.
• If you do not receive any documentation from an agency / organization within 30 days of its
receipt of your proposal, you must provide the agency / organization with a follow-up letter
requesting comment on your proposal within 15 days from the date of the follow-up letter. If
you still do not receive any response as a result of the second letter, type "NO. RESPONSE"
Duke Energy Page 1 of 13 rev t �2zm
Excavation Program

at the top of the follow-up letter and include it in the application along with proof of the
agency's / organization's receipt of the letter (e.g., Certified Mail receipt). You may proceed
with the application process recognizing, however, that if its comments come later in the
application process, you will be required to address them.
• From the United States Army Corps of Engineers (Corps): (** Note — The Corps may have
additional forms to submit for your proposal and an additional fee.) If the excavation can be
done under the requirements of the General Permit (GP) or a Nationwide Permit (NWP), you
will typically receive a copy of the Corps' tear sheet documenting authorization and
providing any additional instructions. If the excavation isn't covered under the GP or a
NWP, you'll be required to obtain an individual 404 Dredge and Fill permit from the Corps.
You must receive written documentation from the Corps that your application either (1)
meets the requirements of the GP or a NWP or (2) the proper 404 Dredge and Fill permit has
been received before Duke Energy can process your application.
• From the North Carolina Department of Environmental Quality (NCDEQ), Division of
Water Resources: (Note NCDEQ may have additional forms to submit for your proposal
and an additional fee.) If the proposal meets the requirements of the Clean Water Act Sect.
401 Water Quality Certification, you will typically receive a letter from the NCDEQ Division
of Water Resources documenting Sect. 401 Certification and providing any additional
instructions. You may also receive a letter requiring additional information or
recommending modifications. You must receive written documentation from NCDEQ
noting any required Sect. 401 Certification has been received before Duke Energy can
process your application.
• From the North Carolina Wildlife Resources Commission (NCWRC): If you do not receive
any documentation from the NCWRC within 30 days of their receipt of your application, you
may proceed with the application process without submitting a follow-up request,
recognizing however if comments come in later in the application process, you will be
required to address them.
• From the South Carolina Department of Health and Environmental Control (SCDHEC):
(Note — SCDHEC may have additional forms to submit far your proposal and an additional
fee.) The SCDHEC conducts ajoint application process with the USACOE in S.C. If the
proposal meets any applicable requirements of the Clean Water Act Sect. 401 Water Quality
Certification, you will typically receive a letter from SCDHEC documenting Sect. 401
Certification and providing any additional instructions. You may also receive a letter from
USACOE requiring additional information for the agencies participating in the joint
application process. You must receive written documentation from SCDHEC noting Sect.
401 Certification has been received if required before Duke Energy can process your
application.
• From the South Carolina Institute ofArchaeology and Anthropology (SCIAA): The applicant
must wait 30 days after receiving the signed postal returned receipt. If a response from
SCIAA has not been received by this time you may proceed with the application process
without submitting a follow-up request, recognizing however if comments come in later in
the application review process, you will also be required to address them.
Duke Energy Page 2 of 13 rev t �avzi
Excavation Program

Step 4: Final Application & Submittal to Duke Energy
Following the consultation process, finalize the application. The final application submitted to
Duke Energy should incorporate all comments and recommendations provided by agencies and
organizations during the agency consultation process as well as copies of all permits received. In
addition to the final application include the following:
• One check payable to Duke Energy for the application fee and security deposit
• If applicable, a separate check payable to the appropriate Habitat Enhancement Program fund
• Signed Excavation Program Applicant's Agreement
Note: Co -applicants must also submit the application fees and applicable HEP fees with the
application.
Duke Energy Page 3 of 13 rev t trzvtt
Excavation Program

Duke Ene_rw Excavatiou Permit AlMsfication Fonts
Dube File No,
Application Fee Security Deposit$ CheckH Date Received Initials
Date of Duke Energy Lake Services, applicant and/or coaherbu,0-eiteiospectiom Date JklsI 3 hadial.
Date Firm ProtectiodAvoidanceArea Markiaga Field - Verified —.
Initiak
Approved to Start Wmk 13y •: _ _
Date Completion Required ....Date of My Approved Extensio¢ (Sig.)
Initials
Date Passed Cloaeoutlnapectlon" Initials
Any Stop Work Orden or SMO V101shown(check one) Dyes 13NO UfYes, arp/ain in PART V)
Datc DapOadReOmded Initials_ Date Permit Database Updated Initials
' Forward COPY of approved application (all pages, Plus my attachments that Duke
ith pjication. Energy changed) back to applbmt
highlight with Approval I&Wr and any chaOges No copies of Approval and CuOserout Checklists and any Stop Work
Orden w
PartL Applicant Information (Please PrrnO
Name Yvonne Moore Telephone [phone]
Entail address: 4221swoodna.smail com
Lake Address
8054 Summit Rid pr,
Mailing Address (tfdiferent)
2910 Havil „d Court
Contractor Company Lancasters Custom Dock and Lift Systems Inc.
Contractor Contact Person Donna P Hrko Telephone [phone]
Contractor Email Address: donnalancasterdocksAgLnai] com
LAKE LOT INFORMAXION
Lake Norman County Catawba
City Catawba State
NC Tax Map No.
471001067307
Subdivision The summit atLeko Noreen 3
Lot / Section No. Lot #16
Lot Size
90 Acres
Duke Energy Page 4 of 13
Excavation Program rcv itZ21

Duke Energy Excavation Permit Application F
orm
Security Deposit Refund Information
The security deposit will be refunded after the excavation permit has expired if no violations of
the approval occurred. The applicant will receive the security deposit refund at the mailing
address in Part I unless an alternative recipient is identified.
Send the security deposit to an alternative recipient? (check one) Yes X [3No (If yes,
include name and mailing address below.
Name: Lancastergatom DoCkMdLift SYstema Joe.
Tax ID: 56-1936944
Mailing Address: 1156 Perth Road
Troutman. NC 28166
Are there any Co -Applicants*? (check one) Dyes tBNo (if Yes, include names, street
addresses or lot numbers, pier numbers, phone numbers, and email addresses in Part V — Additional Information)
* Co -Applicants exist when the proposed work is being done under a single application, will be
Performed by a single contractor as one continuous project, and is done to benefit multiple
more than 4 co -applicants in addition to the lead applicant on any application. owners / lease holders of Project -front properties within a single development. There can be no
Do not continue the application until an on -site inspection has been conducted between a
Duke Energy Lake Representative and the applicant an
the excavation contractor.
NOTE., Initialing this portion of the application by a Lake Representative in nway
fthe excavation or any other lake use permitting
constitutes approval or eminent approval o
activity.
Date of on -site inspection --it
Initials (Duke Energy) �fry
(applicaut/eontractor)
Duke Energy Page 5 of 13 rev iirmi
Excavation Program

Duke Energy Excavation Permit Application Form
Part U. Description of Project
A. Basic Information
1. Type of excavation: (check one) ❑ New excavation © Maintenance excavation
2. Purpose of excavation: (check one) ©O Boat Access Channel
❑ Water Intake Channel ❑ Wastewater Discharge Channel
❑ Other (spec):
3. Lake user category: (check one) OPrivate OResidential Marina
❑Commercial Marina ❑Public
OOther (spec fy):
4. Max. Excavation Area Dimensions (ft): Length 70' Width 32' Depth 8'
(Note: include additional area dimensions ifnecessary so response to #5 below equals max. area
dimensions in 44)
S. Volume of Excavated Material (TOTAL for the project): 176 Cubic yards
6. Type of material removed (applicant determines b eld sample tfpractical)
Sand, silt and clay
7. Excavation Site area:.051 Acre (s) Disposal Site area: .051
8. Total Disturbed Area (including equipment staging area):.102 Acre(s)
9. Does the project meet the requirements of the applicable General Permit? (check one)
Oyes ONo
10. Do you claim title to the disposal area? (check one) OYes I]N
11. Do you claim title to the equipment staging area? (check one) ❑Yes X No
12. Are there any water -treatment facilities within 50 feet of the proposed excavation area?
(check one) DYes ❑x ONo
(If Yes, spec):
13. How will the excavated material be entrapped and the erosion controlled? (e. v. cee attached
erosion control plan and disposal area design): V
Dredge with long reach excavator. Place materials in hopper barges. Haul away by barge to offload into
dump trucks and transport to disposal site.
Duke Energy Page 6 of 13 rev ❑1
Excavation Program

Duke Energy Excavation Permit Application Form
14. Type(s) of excavation a uipment to be used:
Long Reach Excavator, Short Reach Excavator, Barges and Dump Trucks
15. Will waters or wetlands be crossed in transporting equipment to or from the site?
(check one) 'i'Yes ONo
(Ifyes, explain)
Dredging equipment will be transported via floating plant from Lancaster Custom Dock office and staging
area across Lake Norman to the project location.
16. Will return water re-enter the reservoir? (Check one) OYes ONo SN/A
17. Is there an existing facility (e.g. pier) that access is being maintained to by conducting the
excavation? XYes ONo
(If Yes, provide the existingpermit number. If No, include a scaled drawing ofthe proposed
facility). Permit #Duke Tae #9760
18. Total planned duration of the work (Include first equipment mobilization, excavation
through final mitigation measures complete):
START 11 / 23 FINISH 2 / 24
(Month) (Year) (Month) (Year)
Duke Energy Page 7 of 13 rev uav'z�
Excavation Program

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Duke Enerev Excavation Permit Apolication Form
C. Applicant's Sienatures
Comments:
Applicant Name (print) Yvonne Moore
Applicant Signature*Date 9/15/2023
Co -Applicant Name (print)
Co -Applicant Signature* Date
Co -Applicant Name (print)
Co -Applicant Signature* Date
Co -Applicant Name (print)
Co -Applicant Signature* Date
Co-Applicaut Name (print)
Co -Applicant Signature* Date
*Per my signature, the information provided in this application is correct to the best of my
knowledge.
Duke Energy Page 10 of 13 rev 112MO21
Excavation Program

Duke Energy Excavation Permit Application Form
Part M. Additional Information
A. Deed and Survey Plat: A copy of the deed and registered survey plat or other instrument
under which each applicant and co -applicant claims title to the affected property (the
shoreline adjoining the excavation area, equipment staging area, area crossed by any spoil
and return water lines, and the disposal area). If the applicant(s) is(are) not the owner(s) of
said property, then forward a copy of the deed and registered survey plat or other instrument
under which the owner(s) claim title plus written authorization from the owner(s) to carry
out the project on their land.
B. Excavation Area Drawing: An accurate drawing of the area to be excavated. The drawing
must show at a minimum, a North arrow; the boundaries and acreage of the proposed
excavation area and equipment staging areas; lake, county, city, cove, tributary, road and
subdivision names and lot numbers (as applicable); property corners for project front lots;
the full pond elevation contour and lines dividing the cove width into equal thirds (as
applicable); approximate volume in cubic yards of the material to be excavated; point(s) of
return water re-entry; the boundaries of any adjoining areas that are to be specifically
avoided or protected during the work and the location (address) of the disposal area for the
excavated material. [NOTE: A copy of this drawing must also be provided to the
excavation contractor to ensure restricted areas are not impacted.]
C. Disposal Area Drawing: An accurate drawing of the proposed design for the disposal area
The drawing must show at a minimum, a North arrow; the boundaries and acreage of the
proposed disposal area; lake, county, city, cove, tributary, road and subdivision names and
lot numbers (as applicable); the full pond elevation contour (unless disposal is well away
from the lake); the boundaries of any adjoining areas that are to be specifically avoided or
protected during the work; the location (address) of the excavation area from which the
material came and a statement of the disposal area's capacity with all dimensions labeled
that were used in the volume calculation. [NOTE: A copy of this drawing must also be
provided to the excavation contractor to ensure restricted areas are not impacted.]
Also note for projects larger than one (1) acre in North Carolina, including excavated,
equipment staging, and disposal areas, you must submit an erosion control plan. For
projects larger than two (2) acres in South Carolina, including excavated, equipment staging
and disposal areas, you must submit an erosion control plan. For projects < two (2) acres in
South Carolina, you must submit a completed standard reporting form for construction sites
disturbing two (2) acres or less to the South Carolina Dept. of Health and Environmental
Control (SCDHEC) - Stormwater Management
D. Vicinity Map and Driving Directions: A vicinity map and directions by road showing
directions to both the excavation area and disposal area. Include the latitude and longitude of
both the excavation area and the disposal area.
Part IV. Agency Reviews and Approvals
Begin this section with a summary table of all agencies consulted and applicant response to
agency comments as shown in the example table below. Agencies should be listed in the order
Duke Energy Page 11 of 13 rev 11=021
Excavation Program

Duke Energy Excavation Permit Application Form
shown in the Agency/Organization List. Consultation letters must be dated within the two years
preceding Duke Energy's receipt of the application.
Table IV-1. Sample Aeenev Comment And Resnr.Aan Tnhla
Agency Comment.
Applicant Response
A enc 1
The activity is approved as proposed.
NA
Agency 2
The on -site well provides drinking water to the
Contacted Mr. Smith on I/l/20xx. No
public. Please contact Mr. Smith to discuss the
further action needed.
proposed changes and potential issues
associated with your proposal.
You must contact us immediately if
Applicant will contact Agency 2 if
endangered species are located during the
endangered species are located during
course of construction.
construction
Agenc,E 3
Requested agency comments on 1/1/20xx and
NA
again on 2/l/20xx. No response as of
2/16/20xx.
A enc 4
Section 401 Water Quality Certification
Applicant will comply with the conditions of
the 401 Water Qualit Certification
Following the table of agency comments and applicant responses, include atable of permits and
certifications issued by the reviewing agencies. As with the table of agency comments and
applicant responses, agencies should be listed in the same order as they are listed in the
Agency/Organization List.
Table IV-2. Sample Aeenev Permits and Certif;entln.. TAM.
Agency
Permit/Certification Name
Date of
Date of
Issuance
Expiration
Agency I
Surface Water Withdmwal Permit
Agency 2
Section 401 Water Quality Certification
Following the two summary tables, include a copy of all correspondence to and from any local,
regional, state and federal agencies or other organizations with which you are required to consult,
including any required permits (e.g., Section 401 water quality certifications, Section 404
dredge/fill permits, building permits, etc.) or other approvals or comments which have been
obtained from these organizations regarding this activity. Include a copy of any local, regional,
state or federal regulations or guidelines that will be followed. All permitting issues must be
resolved and clearly documented. Correspondence should be organized in the order the agencies
are listed on the Agency/Organization list with the applicant's request for comments followed by
additional correspondence in chronological order. All permits must be valid at time of
Duke Energy Page 12 of 13 rev U/M021
Excavation Program

Duke Energy Excavation Permit Application Form
application and have a term longer than the projected schedule for completing the permitted
project.
Part V. Additional Information
Provide relevant additional information. Reference previous parts as applicable. Include the
FERC-required Environmental Assessment if you were directed to do so during the initial site
visit. If there are co -applicants, this is where their information would be provided (see Part 1).
Duke Energy Page 13 of 13 rov 112MO21
Excavation Program

37921539
FILED ELECTRONICALLY
CATANEA COUNTY NC
DONNA HICKS SPENCER
NORTH CAROLINA GENERAL WARRANTY DEED
Excise Tax: $320.00 / Parcel Identifier No. 0801297
FILED Feb 06, 2023
AT 04:14:00 EM
BOOK 03792
START PAGE 1539
END PAGE 1540
msmuema T A 02037
EXCISE TAX $320.00
This instrument was prepared by: David T. Kasper, a licensed North Carolina attorney. Delinquent taxes, if
any, to be paid by the closing attorney to the county tax collector upon disbursement ofelosincrnrncgndc.
Brief description for the Index: Lot 16, The Summit at Lake Norman
THIS DEED made this 2nd day of February, 2023, by and between
GRANTEE
Brian C. Adair, Unmarried Kyle G. Moore and wife
Yvonne Moore
625 40ih Ave Lake NW 7930 Haviland Ct.
Hickory, NC 28601 Pfafftown, NC 27040
The designation Grantor and Grantee as used herein shall include said parties, their heirs, successors, and assigns, and shall include
singular, plural, Muscu0ne, feminine or Reuter as required by contest.
WITNESSETH, that the Grantor, for a valuable consideration paid by the Grantee, the receipt of which is
hereby acknowledged, has and by these presents does grant, bargain, sell and convey unto the Grantee in fee
simple, all that certain lot, parcel of land or condominium unit situated in Catawba County, North Carolina and
more particularly described as follows:
BEING all and the full contents of Lot No. Sixteen (16) of THE SUMMIT AT LAKE NORMAN,
SECTION III, MAP 1, as the same is platted, planned and recorded in Plat Book 48 at Page 134 in the
Catawba County Public Registry.
The property hereinabove described was acquired by Grantor by instrument recorded in Book 3504, Page 1111.
No portion of the property herein conveyed contains the primary residence of the grantor.
A map showing the above -described property is recorded in Plat Book 48, page 134.
submitted electronically by "Kasper b Payne, P.A."
in compliance with Korth Carolina statutes governing recordable documents
and the terms of the submitter agreement with the Catawba county Register of Deeds.

3792 1540
TO HAVE AND TO HOLD the aforesaid lot or parcel of land and all privileges and appurtenances thereto belonging to the Grantee in
fee simple.
And the Grantor covenants with the Grantee, that Grantor is seized of the premises in fee simple, has the right to convey the same in
fee simple, that title is marketable and free and clear of all encumbrances, and that Grantor will warrant and defend the title against the
lawful claims of all persons whomsoever, other than the following exceptions:
Easements and Restrictions or record, if any, and current years Ad Valorem Taxes.
IN WITNESS WHEREOF, the Or r has duly executed the foregoing as of the day and year first above written.
i
(SEAL)
Bris .Adair
"" —,x,.vu ,svuay raonc or me county or Crty of and State aforesaid, certify that Brian C.
Adair. Unmarried, personally appeared before me this day and acknowledged the due execution of the foregoing instrument for the
purposes therein expressed. '
Witness my hand and Notarial stamp or seal this , day of &. r 2023.
My Commission Expires:-3—
(Affix Seal) bCrn -LhL NotaryPublic
Notary's Printed or Typed Narde
,d A13 rriryrqy��
Notary Potato y3s 's
Burks
County 5
yTtirCARr��s`p.

THE INFORMArFCN CONTAINEDIN THIS DRAWING IS THE SOLEPROPERTY OF,,NLASTER'S DOCK& UFTS SYSMMNC I. ANY REPROWCT/ON /N PART OR ASA WHOLEWITH uTTHEWR/TiEN PERMISSION OF LANLASTER5OOCK &LIFTS SYSTEM INC. IS PROHIBITED.
ISSUE CLIENT
0 8-11-23 Moore Dredge
DRAM W 8054 Summit Ridge Dr
M.H. Lot 18
Catawba N.C. 28609
Lancaster Custom Dock and Lifts
1156 Perth Road Troutman
North Carolina
ZtAM"*NOCl7=M;,R

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DUKE ENERGY DIRECTIONS BY ROAD FORM
Lake Use Permit Applicants and Contractors: Ease of locating the proposed project
site canhavea big impact on permitting processing time. Please complete this form and
return it along with your completed application to:
DUKEENERGY
C/O LAKE SERVICES — EC 12 Q
526 SOUTH CHURCH STREET
CHARLOTTE, NC 28202
Applicant's Name:
Street Address (at lake): _ 8054 Summit Ridge Drive
Lake Name:
Subdivision Name: The Summit at Lake Norman 3
Property Section: Lot #:
City: Catawba County: Catawba
State:
Telephone: [phone]
Zip: 28609
Directions (from major road or highway):
From I-77 NB, Exit 36, Left onto NC-150 WB into Catawba County, Right onto
Sherrills Ford Road, Right onto Molly's Backbone Road, Right onto Hopewell
Church Road, Left onto Summit Ridge Drive, Property is on the left.
Descriptive Structure(s) on Property (i.e. brick garage, white fence, mobile
home, etc.)
*Note: Please use the back of this form if desired to draw us a map to the site.

8054 Summit Ridge Drive. Catawba, NC 28609
0 250 500 ft -V 'I'
01
Long Island
Marina
35.674476,-80.983559
sMaps Legal
CRM ♦ Deg ♦ DMS Help
Decimal Degrees Latitude: (35.674476
Decimal Degrees Longitude:-ao.sa3559
Clear Show Point

DUKE ENERGY DIRECTIONS BYROAD FORM
I.ANCASTER CUSTOM DOCKS DISPOSAL SITE
Lake Use Permit Applicants and Contractors: Ease o site canhawa big impact on permitting processing titre. pf leaselthe proposed pmjeet
ocating
return it along with your completed application to: complete this form and
DUKE ENERGY
C/O LAKE SERVICES —EC 12 Q
526 SOUTH CHURCH STREET
CHARLOTTE, NC 28202
Applicants Name; Lancaster Cllg= Dock Di ik
Sheet Address (at lake): 1162 Ri er iW,,, Mooresville. NC
Lake Name: TIT ----
Subdivision Name: _ Bia Daaa�.>_
Norma_
Property Section: Lot #:
City: -Mooresville CounTy,
State: _. NC
Zip: _ 28117
Telephone: _ _ 0
Directions (from major road or highway): From I-77 NB, Exit 36, Left onto NC-
150 WB, Disposal Area is on the right behind Big Daddy>s Restaurant
Complex.
Descriptive Structure(s) on property (i.e. brick garage, white fence, mobile
home, etc.)
*Note: Please use the back of this form if desired to draw as a map to the site.

1162 River Highway Mooresville,NC 28117
0 250 500 750 ft oil
RUSTIC WAY LN
2
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2
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p
Performance
1 Hitch and Trucl
Accessories
35.604043• 80.910286
Drag Me!
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Foothills Marine
dMaps LeaalofLake Norman _ +
CRM ♦ Deg ♦ DMS Help
Decimal Degrees Latitude: 35.604043
Decimal Degrees Longitude: -a0.910286
Clear Show Point

DREDGE SPOIL DISP LSAAL FORM
Project Name/address: ire �Y� 1`a- W/'rL('Jecf)
tOJ�ndrel s: I I /,, � Z$Y(a unty: �r �� poses/
Ile,
rcel#:_INCkln��r
"1 �0.�� ill I Q 9 1 u
Disposal area required (sq ft and/or acreage) r
Acknow men jNot/jlcot/on
rhr^r' iP V' am aware that the site must adhere to all state regulations
and rules remfanSer sion crol and water qu�lity. And give permission for
ding lath Tro �— }1 i JV giye rvameoflndiwdualand Company C �Sr
to dispose of their dredge material at the above stated location
Owner:l!l� II to L G
Date: 9-1 C5 Pri
Along with form, please provide:
Aerial of parcel/lot (County GIS)
Photo of proposed spoil site
Identified proposed spoil site

catawba county Geospatial Real Estate Search
uuxo. uvus. unu, Information .Services
N
w+ 1 in=40ft
s
Parcel: 471001067307, 8054 SUMMIT RIDGE DR CATAWBA, 28609
Owners: MOORE KYLE G, MOORE YVONNE
Owner Address: 7930 HAVILAND CT
Values - Building(s): $5,000, Land: $87,500, Total: $92,500
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Copyright 2023 Catawba County NC
09/12/2023

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AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO: 40 PLAN NO: PARCEL ID: 462802650295
STREET ADDRESS:
9746 Riviera Drive
Shernins Ford, NC 28673
Please print:
Property Owner Gilbert L. Moore
Property Owner:
The undersigned, registered property owners of the above noted property, do herebyauthorize
Donna P. Hrko , of _Lancaster's Custom Dock and Lift Systems Inc
(contra=r/Agent) (Name of consulting R.)
to act on my behalf and take all actions necessary for the processing, issuance and acceptance of this
permit or certification and any and all standard and special conditions attached.
Property Owners Address (If different than property above):
Telephone: [phone]
We hereby certify the above information submitted in this application is true and accurate tothe
be" our knowledge.
Authorized Signature- Authorized Signature
4/26/2021
Date n,«e