20241402 Ver 1_Shoreline Stabilization_20241016

Shoreline Stabilization Application Form
NORTH CAROLINA
Environmental Qualify
15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
FORM: SSGP 10-2013
Submission Form
I. Applicant Information [15A NCAC 02H .0502(a)]
Please note: fields marked with a red asterisk * below are required. You will not be able to submit the form until all
mandatory questions are answered.
Primary Contact Email *
[e-mail]
Please provide an email address for payment and requests for more information here.
Owner Information:
.............................................................................................................
Name: * CHRISTINE SOWA
Email: * [e-mail]
Phone Number: [phone]
(xxx)xxx-xxxx
Mailing Address: *
Street Address
313 Lockhard Circle
Address Line 2
City
Troutman
Postal / Zip Code
28166-7639
Is there an agent working on the project?*
Agent/Consultant Information
Name: *
Company Affiliation:*
Email: *
Phone Number: *
Yes
No
LAKE PERMIT LLC
State / Province / Region
NC
Country
US
LAKE NORMAN DREDGE & MARINE
CONSTRUCTION
[e-mail]
[phone]
(xxx)xxx-xxxx

Mailing Address: *
Street Address
PO BOX 5335
Address Line 2
City State / Province / Region
MOORESVILLE NC
Postal / Zip Code Country
28117 US
A signed and dated copy of the Agent Authorization letter:*
SOWA AUTH.pdf
SOWA AGENT.pdf
Link to: Sample Agent Authorization Form
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name: *
SOWA
2.38MB
875.24KB
If your project has a formal name please use this. If your project does not have a formal name, please identify your project
by the owner name and proposed activity (Jones Property Access Road, Smith Guest House, etc.) List in parentheses
any other names that have been used to identify the project in the past.
1. Provide 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. *
Upload File
Look up address
Upload Map:
Latitude: *
35.662068
Longitude: *-80.908642
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, and construction access corridors. You may use the diagram under
section 12.normal pool lake level/normal water level *
Please use the diagram at the link below:
https://edocs.deq.nc.gov/WaterResources/0/edoc/616616/Shoreline%20Layout.docx

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)
Nearest Town: * TROUTMAN
County:* Iredell
Lake/ river/ ocean adjacent to NORMAN/ CATAWBA
property:
Subdivisions name or site address:*
ALLISON ACRES #1 SUB
Include phase/lot number
Directions to site: *
FROM MARSHALL STEAM STATION TRAVEL EAST HWY 150- 4.2 MILES, LEFT PERTH RD 6.0 MILES, LEFT STATE
PARK RD 1.2 MILES, LEFT LOCKHARD CIR .60 MILES, RIGHT LOCKARD CIR 250 FT, PROPERTY ON RIGHT
Please include road names and numbers, landmarks etc.
5. Describe the existing land use or condition of the site at the time of this application: *
RESIDENTIAL
Residential, undeveloped, etc.
6. Property Size .46
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been avoided, or
why it is necessary):
DREDGE 18' X 30' X 3' DEPTH
CHANNEL - 25'X 177' X 3' DEPTH WHICH WOULD BE THE CHANNEL TO BE INCLUDED INTO TWO OTHER
NEIGHBORS.
8. How will the work be done?
From Land
From Water
9. Total amount of disturbance below the normal pool lake level/ normal water level: *
(including all clearing, back fill, excavation, rip rap, retaining walls, etc.)
540
square feet
10. Total amount of disturbance above the normal pool lake level/ normal water level and 50 feet land-
ward:*
*
(including all clearing, back fill, excavation, rip rap, retaining walls, etc.)
0
square feet

11. 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)
NO TREES REMOVED
Sketch: SOWA SKETCH.pdf 1.37MB
Application Fee:
Once the application has been accepted. You will need to send a corresponding fee in with the appropriate DWR#. The
application fee is as follows (pursuant to G.S. 143-215.3D):
o $323.00 for impacts to lake (below normal water level) of less than 1 acre
d $767.00 for impacts to lake (below normal water level) of greater or equal to 1 acre
By digitally signing below, I certify that:
d I, the project proponent, hereby certifies that all information contained herein is true, accurate, and complete to the best
of my knowledge and belief
d I, the project proponent, hereby requests that the certifying authority review and take action on this CWA 401
certification request within the applicable reasonable period of time.
o I agree that submission of this Shoreline Stabilization online form is a "transaction" subject to Chapter 66, Article 40 of
the NC General Statutes (the "Uniform Electronic Transactions Act");
o I agree to conduct this transaction by electronic means pursuant to Chapter 66, Article 40 of the NC General Statutes
(the "Uniform Electronic Transactions Act");
o I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written
signature; AND
o I intend to electronically sign and submit the Shoreline Stabilization online form.
Full Name: * CHRISTINE SOWA
Signature:
cN s7IiuF- 5o114-
Submittal Date: 10/14/2024

Initial Review
Is this accepted into the review process? * Yes No
Project Number:* 20241402 Version:* 1
Select Reviewer: * Jesse Mcdonnell:Jesse.Mcdonnell
Select Reviewing Office: Mooresville Regional Office - [phone]
Has payment been received?* No Payment Needed
Fee Received
Need Fee - send electronic notification
What amount is owed?*
$240.00 $570.00
$323.00 $767.00

CATAWBA RIPARIAN BUFFER NOTIFICATION FORM
Project Name/address: Lbs/V A / 3 II 3 1-CX-14]-/A4'C-g. fi(
Owner: C e, 07//4 c2 W A —
Print
Contractor/agent:
Sier,ature
Print L..& E Pi: /t'rr '- c Sig
ounty:
The 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. [15A NCAC
02ni .0506 and 15A NCAC 02B .0243(8)]
Trees are not allowed to be removed from Zone 1 of the Buffer (within 30 ft of the full pond elevation), unless
approved. EAception, those trees that are severely undermined along the immediate shoreline can be removed.
Minimal shaping arse sloping along the immediate shoreline is allowed. [15A NCAC 02B .0243(6)]
Benching, grading in the buffer is not allowed. Excessive disturbance of ground cover. [15A NCAC 02B .0243 (6)]
i e.acr►es, impe pious patios, impervious walkways, etc. are not allowed in the buffer unless specifically approved
by the Division. Triere are limitation on size for decks. [15A NCAC 02B .0243(4) and (6)]
Work to be. conducted 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 shall be restored. Staging, spoil, construction
material muss oe cut ice the buffer. [15A NCAC 02H .0502 and 15A NCAC 02B .0243 (4), (6), (8)]
Stormwater cannot be piped or channeled for direct discharge to the lake. All constructed stormwater
ulscharges must oe a.c the natural elevation and discharged prior to entering the buffer directed as diffuse or
sheet flow at non -erosive ,velocities to the lake. [15A NCAC 02B .0243(S), (6)]
Ae ui'9owledg,; lJent Notification
[ii('r'j/ts '1 kte- So In1A- , hereby state that I have been informed of the Catawba
Riparian uf.. :u:e...i v- work conducted in the buffer, not specifically stated in the application and approved
by the Division of Water Resources (DWR), is a violation and subject to enforcement. Due diligence will be
:ai,:en such xi:at c1;.s;�: action will be built within substantial compliance and intent of the 401 Water
Quality Certification and Buffer,ules, the approved]/pian(s) and specification(s), and other supporting
;,2terials.
nature ( unem')
Date: AVoliall

AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO. c- 4 PLAN NO.
PARCEL ID: Ll73cD -3/-O3('4-c -°
STREET ADDRESS: L 3 LCQ-(,L4+-,D city_
-176u?'i4A/V /V c 09T/(oG
Please print: CA-het-Sri/Ur
�
Property Owner: tSri,U' ,�-
Property Owner:
The undersigned, registered property owners of the above noted property, do hereby authorize
Oredje , of Lai /Ge i'vr c
LL
(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: 7- 575
5
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
uthorized Signature
Date: 1 D/3/d g
Authorized S ature
Date: /0 l ai. f

AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO. a Cr PLAN NO. —
—
PARCEL ID: LI73C7 - 3l — ®3co4 -c ro
STREET ADDRESS; 31e��--
Please print:
Property Owner: lal,4—
Property Owner:
The undersigned, registered property owners of the above noted property, do hereby authorize
LA44,' Ilh/J*4AJ Di-e e , of Lai /GE /MdT LGG
(Contractor if 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: 7 cc" - 6-75 -
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
uthorized Signature
Date: 1(7i31c)7
Authorized S. ature
Date: IO'I0' I

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Mail to:
Drawn by:
11111111 III IIIN IIIII IIIII tI1111IIIII I 11111111111311111
Doc ID: 012875600002 Type: CRP
Recorded: 03/24/2010 at 01:25 19 PM
Fee Amt: $22,00 Page 1 of 2
Revenue Tax: $0.00
Iredell county, NC
Brenda 0. Bell Register of Deeds
BK2055 PG1228-1229
SPECIAL WARRANTY DEED
Christine M. Sowa, a sin le woman
313 1DCkhar Gird,
Troutwtan 1 NC Alta,
i8hapiro & Ingle, L.L.P.
520 Cliff Cameron Drive, Suite 300
Charlotte, NC 28269
If the initials of any Grantor or agent appear, the property includes the primary residence of at least one of the
Grantors. (N.C.G.S. § 105-317.2):
Tax ID#: 4730310364.000 EXEMPT
STATE OF NORTH CAROLINA
COUNTY OF IREDELL
THIS INDENTURE Made this 2nd day of March, 2010, between Federal National Mortgage Association, hereinafter
GRANTOR, whose address is 14221 Dallas Parkway., Suite 1000, Dallas, TX 75254 and Christine M. Sowa, a single woman,
hereafter GRANTEE, whose address is 313 LOCVinai'd Circle, Tract WW1 Zrbl(ot1 . The
designation Grantor and Grantee as used herein shall include said parties, their heirs, successors, and assigns, and shall
include singular, plural masculine, feminine or neuter as required by context.
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 or parcel of land situated in Iredell County, North Carolina and more particularly described as follows:
Being all of Lot 26 of Allison Acres No. One (1), a plat of which is duly recorded in Plat Book 7 at Page 54 in the
Iredell County Public Registry, to which reference is hereby made for a more particular description.
Property Address: 313 Lockhard Cir, Troutman, NC 28166
TO HAVE AND TO HOLD the aforesaid lot or parcel of land and all privileges and appurtenances thereto belonging to
Grantee in fee simple.

And the Grantor covenants with the Grantee, the Grantor has done nothing to impair such title as Grantor received,
and Grantor will warrant and defend the title against the lawful claims of all persons claiming by, under or through
Grantor.
Federal National Mortgage Association, by and through its
attorney in fact Shapiro and Ingle, LLP
By: Wendy F. Neill Authorized Signatory
STATE OF NORTH CAROLINA
COUNTY OF MECKLENBURG
On this Second day of March, 2010, before me, the undersigned Notary Public, personally appeared Wendy F. Neill
personally known to me to be, an Authorized Signatory of Shapiro and Ingle, LLP and being by me duly sworn and
known to me to be the person who executed the within instrument on behalf of said Shapiro and Ingle, LLP, a
company that executed and whose name is subscribed to the within instrument as the attorney -in -fact for Federal
National Mortgage Association and acknowledged to me that he/she subscribed the name of Federal National
Mortgage Association thereto as principal and the name of Shapiro and Ingle, LLP as attorney -in -fact for said
Federal National Mortgage Association and that said Company executed the same as such attorney in fact and that
the authority to execute and acknowledge said instrument is contained in an instrument duly executed,
acknowledged, and recorded in the Office of the Register of Deeds, County of Iredell, State of North Carolina, on
the Sixth day of January, 2009, Book 1979, Page 1385.
WITNESS my hand and official seal.
(CZ
a Leigh Rh
ry Public
My Commission Expires: November 14, 2010
09-112089 -JR

Mail to:
Drawn by:
11111111 III IIIN IIIII IIIII tI1111IIIII I 11111111111311111
Doc ID: 012875600002 Type: CRP
Recorded: 03/24/2010 at 01:25 19 PM
Fee Amt: $22,00 Page 1 of 2
Revenue Tax: $0.00
Iredell county, NC
Brenda 0. Bell Register of Deeds
BK2055 PG1228-1229
SPECIAL WARRANTY DEED
Christine M. Sowa, a sin le woman
313 1DCkhar Gird,
Troutwtan 1 NC Alta,
i8hapiro & Ingle, L.L.P.
520 Cliff Cameron Drive, Suite 300
Charlotte, NC 28269
If the initials of any Grantor or agent appear, the property includes the primary residence of at least one of the
Grantors. (N.C.G.S. § 105-317.2):
Tax ID#: 4730310364.000 EXEMPT
STATE OF NORTH CAROLINA
COUNTY OF IREDELL
THIS INDENTURE Made this 2nd day of March, 2010, between Federal National Mortgage Association, hereinafter
GRANTOR, whose address is 14221 Dallas Parkway., Suite 1000, Dallas, TX 75254 and Christine M. Sowa, a single woman,
hereafter GRANTEE, whose address is 313 LOCVinai'd Circle, Tract WW1 Zrbl(ot1 . The
designation Grantor and Grantee as used herein shall include said parties, their heirs, successors, and assigns, and shall
include singular, plural masculine, feminine or neuter as required by context.
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 or parcel of land situated in Iredell County, North Carolina and more particularly described as follows:
Being all of Lot 26 of Allison Acres No. One (1), a plat of which is duly recorded in Plat Book 7 at Page 54 in the
Iredell County Public Registry, to which reference is hereby made for a more particular description.
Property Address: 313 Lockhard Cir, Troutman, NC 28166
TO HAVE AND TO HOLD the aforesaid lot or parcel of land and all privileges and appurtenances thereto belonging to
Grantee in fee simple.

And the Grantor covenants with the Grantee, the Grantor has done nothing to impair such title as Grantor received,
and Grantor will warrant and defend the title against the lawful claims of all persons claiming by, under or through
Grantor.
Federal National Mortgage Association, by and through its
attorney in fact Shapiro and Ingle, LLP
By: Wendy F. Neill Authorized Signatory
STATE OF NORTH CAROLINA
COUNTY OF MECKLENBURG
On this Second day of March, 2010, before me, the undersigned Notary Public, personally appeared Wendy F. Neill
personally known to me to be, an Authorized Signatory of Shapiro and Ingle, LLP and being by me duly sworn and
known to me to be the person who executed the within instrument on behalf of said Shapiro and Ingle, LLP, a
company that executed and whose name is subscribed to the within instrument as the attorney -in -fact for Federal
National Mortgage Association and acknowledged to me that he/she subscribed the name of Federal National
Mortgage Association thereto as principal and the name of Shapiro and Ingle, LLP as attorney -in -fact for said
Federal National Mortgage Association and that said Company executed the same as such attorney in fact and that
the authority to execute and acknowledge said instrument is contained in an instrument duly executed,
acknowledged, and recorded in the Office of the Register of Deeds, County of Iredell, State of North Carolina, on
the Sixth day of January, 2009, Book 1979, Page 1385.
WITNESS my hand and official seal.
(CZ
a Leigh Rh
ry Public
My Commission Expires: November 14, 2010
09-112089 -JR

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5. DeurUse the existing land use or condition of the site at the time of this application (residential;
uudeveldpado etz):
E. Describe proposed work (include discussion as to how hardening of shoreline has been avoided; or
why it Is nemosary): kaLs _
via woe?, be conducted from woe n From water?
,Ot
8. Th.stal,Juiv of impacts holm the normal pool lake level Normal Water Level
Apacts (Including all excavation, bkflhl, rip rap, retaining walls1 etc.) in square het:
-= 4/ qa (s— hc,r.cs
nn'ilpors;v impacts in square feet:
MtAii Slittjatit of impede deem the normal pool lake lava, / Normal Water Bevel and SO feet land-
Pormanatzt impede (Including back fill, Tat!, rip rap, retaining walls, eite.) lh aquare fQ0,2
14 pc
::21.1:31• cts (temporary clearing, construction corridor) In square fed:
a.=
10. LI:!asise C(i..v.:Erikke the vegetation above the normal poi lake level/ Normal Water Level and SO feet
inciviarci '.c:o be impacted Witter of trees, for WW1*
_Ask_
aignin below, 0, ao the point proponent, aeritifv to the foOkavvino
„,...Apet proponent hereby certifies that all information contained herein Is true, am"
nd =vide to the best of my knowide and belief
":As .y:olect propOnd hereby requests that the certifying ellAtherity review and take eaten on
401 certification request within the applicable reasonable period of time
/34H
• valid o n outhorixation letter from the owner is provided
i4roximately SketC1 the following; informatlen en this plan and wide liknensions for
:,,-.),Rosed vegetation clearing
d rip rap or fill to be pieced above the Full Pond/ Normal Water Leval elevation
tg:2.1on Of rip rap or fill to be placed below the full Pond/ Normal Water Level elevation
• .t. o7 any proposed structures ouch as buildings, (retaining wellso docks, etc.
:Asti of any eneovotion or dredging below the Foil Pond/ Normal Water Level elevation
....,640,23,[bakiguaktilipatemilosa:Quitiz, ; taidagaatijadd. Ems
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Tarineva Hagar
7A-570-2227
Lake PsiPmft LLC
hagerPlakepermitcom

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BOOK 2337PAGE 730 003253
Piled
Date: August 213. 2012 Pgs, 4
Time: 2:06 PM Recording Fees
Book: _2337 $26.00
Page: 730
Danny R. Hester
Register of Deeds
Lincoln County, NC
2337 0730 201202253 DEED
Prepared by: Richard E. Jonas, Attorney at Law, Lincolnton, NC
e Atr reoerding mail to: Grantee
ti 2G )
STATE If NORTH CARCLLiNA
COUNTY OF LINCOLN
Deed ofrSift
INAR Ati` Y DEED
This dry made this air' day of s.�. 7 2012 by and between
P ATHLEEN GOODSON POSHER (KA KATC;ILC F N C ©ODDS©
hereinafter referred to as "Granter and
SAMUEL THO AS C 0®DS©Ni
Address: 7 9 L(d 4 i
hereinafter referr to as "Grantee."
The designeeic n ''Grantor and Grantee" as used herein shall include said parties, their heirs,
personal representatives, successors and assigns and shall include the singular, plural, masculine,
gchlinine car MOM' a required by the context.

aoax 2337PAGE 731
WITi\IESSETH, that the Grantor, for a valuable consideration paid by the Grantee, the receipt of
tivhich is hereby acknowledged, has and by these presents does grant, bargain, sell and convey unto
the Grantee in fee simple, all that certain lot or parcel of land situated in Catawba Springs Township,
Lincoln County, N. C. and more particularly described as follows:
MO of Tan paQceO URN being all of tite Keith Goodson heirs property on the
am was Pn aide of Kddviiie Road, Me @Orin@ being property described in deed '
monied Boole 379, Page UN, 63ook 612, Page 673 and Ei®®is 802, Page TO, to which
did rregsfence its nude kW furke deacrlakan lQ ifi@ent®ratad herein by this
e®aWO Enhibit A for' fd nteo. dead degodotli©r a
TO HAVE AND TO HOLD the aforesaid lot or parcel of land and all privileges and
appurtenances thereunto belonging to the said 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
ei0 encumbrances, and that Grantor will warrant and defend the title against the lawful claims of all
persons whomsoever except for the exceptions hereinafter stated. The to the property hereinabove
described is subject to the following exceptions:
Valid and enforceable reservations, restrictions, conditions, easements and rights -of -ways In
the rem :•. chain of title.
The draftsmen of this deed did not examine Or certify title and did not participate in the closing
of 4his transaction.
9�9 WiTN SS WHEREOF, the Grantor has hereunto set his hand and seal, the day and year
first above written.
- 8EAL)
Kathleen Goodson Fisher

ooat 2337PAGE 732
NORTH CCAROUNA,
COUNTY OF LINCOLN
a Notary Keno for said County and State do hereby ©1ofy that Kathleen Goodson Fisher
personally appeared before his this day and solinowl g v" a due execution of the foregoing
instill ant.
Witness my hand and Nadel OW, this the _ r day of
C emmissien Entree: C 'f yid'
NONA/ Public
z

BOOK 2 27PA6E 733
EXHIBIT A
Pare 134700
8792 Kidvilie "oat
T CT `I : BEGINNING at a stake on West side of a branch in Susan Keever's line, and
runs north 65 % deg. East 93 poles to a white oak; thence North 3 deg. East 47 % poles
to a stone; thence North 25 deg. East 45-7/8 poles to a stone on West side of
Uincointon Road; thence North 9 den. West 22 poles to a stone; thence North 62 % deg.
West o-3ao poles to a stone; thence South 18 deg. West 8 % poles to a stone; thence
North 7816 deg. West-11-1/5 poles to a stone; thence South 861 deg. West 2916
poles to a stake in the Road; thence South 81-3/4 deg. West 29 poles to a stake in the
Road; thence South 44 deg. West 37 poles to a dogwood near a branch; thence South
72 deg. West 22 poles to a cedar; thence South 66 deg. West 46 poles to a stake in the
branch; thence, down the branch as it meanders, to the beginning, being about 99 %
pales, containing 85 acres, more or less.
Deed Reference; Book 379, Page 361,
TRACT 2: BEGINNING at an iron staks, a new corner on the old line of C.A. Keever
and also corner of the property of Keith Goodson, and runs thence with Keith
Goodson's old line, South 89 deg. 10 min. 24 sec. East 482.63 feet to an iron stake,
Keith Goodson's old comer, thence North 1 deg. 34 min. 21 sec. East 69.25 feet to an
iron stake a new comer in the old line at the edge of the right of way of State Road No.
1381, thence three (3) new lines with the lands of C.A. Keever, South 41 deg. 58 min.
17 sec. West 32.85 feet to an iron stake, thence, South 64 deg. 24 min. 18 sec. West
26.52 feet to an iron stake, thence South 86 deg. 42 min. 23 sec. West 436.61 feet to
the point of BEGINNING, containing 0.20 acres more or less.
Deed Reference: Book 603, Page 70.
T CT 3: BEGINNING at a point in the center of N.C. Highway #1381, new corner in
the old A.B. Keever line, and runs thence with the center of the highway South 32 deg.
10 min. East 183.5 feet to a point in the center of the highway (which said corner is
located North 78 deg. 30 min. West 27.4 feet from en old control comer), and runs
thane with other lands of Goodson North 78 deg. 30 min. West 122.5 feet to an old
ccrneF; thence with property of A.B. Keever North 2 deg. 45 min. West 109.8 feet to the
BEG NING.
Deed Reference: Book 512, Page 573.

DREDGE SPOIL DISPOSAL FORM
Project Name/address: SO V J A / 313 L CAC.. LAd CA1C8unty: Zs1 I
Location Address: V 7 ' O Z v iLL4 / DEk4 VET. A..Gc c3- 31
Parcel #: 3(ect 4 02. 12'7 '7
Parcel/lot size
/7 s ,4-c eeS
Disposal area required (sq ft and/or acreage) %)"-C / S
Acknowledgement of Notification
I, C-)cYD,c.S n l , am aware that the site must adhere to all state regulations
and rules regarding sediment and erosion coand water quality. And give permission for
,344A -&L tit,. h AJ Mt . 7 t Li4T Lam. MCP PJ 6r".vc Ate✓ p eraletd— L.—*
Name of Individual and Company
to dispose of their dredge material a
at the above stated location
Owner: SA ter! _ _✓ "Li�l�
Print
Date: V"ol3%c1f
Along with form, please provide:
Aerial of parcel/lot (County GIS)
Photo of proposed spoil site
Identified proposed spoil site

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