4001 Laurel Drive Buffer Request

ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
S. DANIEL SMITH
Director
NORTH CAROLINA
Environmental Quality
DWR Use Only: Project #
Date Received I
Buffer Determination Request Form
Property Owner Information
1.Owner Information
1 a. Name(s) on Recorded Deed
Pedro Jackson ,
I b. Responsible Party (for LLC)
Ic. Mailing Address
4001 Laurel Drive, Durham, NC 27703
I d. Telephone Number
1 e. Email Address
Address of Property: 4001 Laurel Drive, Durham, NC 27703
Project Description (attach plan if available): Residential improvement
Consultant/Agent Information
4. Agent/Consultant Information
4a. Name, Company
Michael Stewart, Stewart -Proctor, Pllc
4b. Mailing address
319 Chapanoke Road Suite 106 Raleigh, NC 27603
4c. Telephone no.
919 779-1855 4d. Email address
[e-mail]
5. Project and Site Information
5a. Name of project
Jackson Lot
5b. County
Durham
5c. Nearest Named Stream
Lick Creek
5d. River Basin
Neuse
6. Has anyone from DWR visited the site?
I Y / N
I N
I Staff Name
I Date of Visit?
Attach a map of the site indicating project boundaries on the USGS 1:24,000 Topo and/or MRCS Soil Survey.
Please return form Josh Brigham
to: 1628 Mail Service Center
Raleigh, NC 27699-1628
Email: [e-mail]
Please contact the Raleigh Regional Office at [phone] if you have any questions.
North Carolina Department of Environmental Quaiity I Division of Water Resources
Raleigh Regional Office 3800 Barrett Drive I Raleigh, North Carolina 27609
919.791.4200

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OURHAM COUNTY, FORTH CAROLINA
27 of 74
§J1 Soil Survey of Durham County,
North Carolina
by United States. Natural Resources Conservation Service
Publication date 1976
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