20150892 Ver 1_Shoreline Stabilization_20150831

AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO, t2 PLAN NO. PARCEL ID: 4603.80 -6193
STREET ADDRESS: 7998 CHERRY POINT DR. DENVER NC 28037
Please print:
Property Owner: JACKSON, PHILLIP L
Property Owner:
The undersigned, registered property owners of the above noted property, do hereby authorize
Dean Fisher of LKN Custom Dock, inc
(Contractor / Agent) (Name of consulting firm)
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 Owner's Address (if different than property above):
Telephone: [phone]
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
03 -L G IVA
Authorized Signature
Date: 6/L Fr if
Authorized Signature
Date:

:.Y,: State of North Carolina
4 Department of Environment and Natural Resources
Division of Water Resources
15A NCAC 02H .0500— Water Quality Certification, Shoreline Stabilization
Division of Water Resources FORM: SSGP 10 -2013
Shoreline Stabilization Application Form
Three copies of the application (including attachments) and the application fee should be sent
to:
Division of Water Resources
401 & Buffer Permitting Unit
1617 Mail Service Center
Raleigh, NC 27699 -1617
Applicant Information [15A NCAC 02H .0502(a)]
1. Owner Information
Name: Phil Jackson
Mailing Address: 7998 Cherry Point dr
Denver, NC 28037
2p'SO8
92
0 2015
Telephone Number: 7044892717 Fax Number:
E -mail Address:
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.
Name: Dean Fisher
Company Affiliation: Lake Norman Custom Dock
Mailing Address: PO Box 1439
Denver, NC 28037
Telephone Number: 7044832144 Fax Number: 8665794539
E -mail Address: Ikndock @email.com
Person to receive the Certification Approval: Dean Fisher
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, structures (buildings, retaining walls, docks, impervious surfaces,
etc.), rip rap, excavation or dredging below Full Pond/ Normal Water Level elevations,
FORM: SSGP 10 -2013 Page 1 of 3

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: Lincoln Nearest Town: Denver
Subdivision name or site address (include phase /lot number):
7998 Cherry Point dr Denver. NC 28037
Directions to site - please include road names and numbers, landmarks, etc.:
Hwy 16N to (RT) at Cherry Point .3 mile on rt at end of rd
Latitude (in decimaidegrees) 35.464978 Longitude (decimaidegrees) - 80.985738
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): Established residential lakefront lot with house and
va rd
6. Property size (acres): 0.72ac.
7. Lake/ river/ ocean adjacent to property: Lake Norman
8. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): Installation by barge of riprap with fabric to stop erosion
of 5 -7ft bank at shoreline. Removal of small underbrush and undermined trees
9. Will work be conducted from land? ❑ no From water? ❑X yes
10. Total amount of disturbance (including all excavation, backfill, rip rap, retaining walls, etc.)
below the normal pool lake level/ Normal Water Level in square feet or acres:
Approx 5x230ft or total 1150sgft along shoreline
11. Total amount of disturbance (including all clearing, back fill, excavation, rip rap, retaining
walls, etc.) above the normal pool lake level/ Normal Water Level and 50 feet land -ward in
square feet or acres: Approx 2x230ft grading/access along shoreline or 660saft total
impacted
12. 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): Existing small trees in
riprap
Dean Fisher Q4 Y 7/27/15
Owner /Agent's Signature* )15A NCAC 62� .0502(f)) Date
FORM: SSGP 10 -2013 Page 2 of 3

FORM: SSGP 10-2013 Page 3 of 3

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Details