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Home My WebLink About20160305 Ver 1_Shoreline Stabilization_2016032817 Shoreline Stabilization Application Form PAS D Three copies of the application (including attachments) and thdApplication fee- should be sent to: Division of Water Resources 401 & Buffer Permitting Unit 1617 Mail Service Center 2 0 1 6 0 3 0 Raleigh, NC 27699-1617 5 • Applicant Information [15A NCAC 02H .0502(a)] I. Owner Information Name: Mailing Address: SAS( (d c_,, i 1C * zo l _La)c.*_ Wa1�+ K.C. 2g�lo Telephone Number: _7011 - gZS - 732-4 Fax Number: E-mail Address: 6'cia '4J5.3.s-io;gal 2. Agent/ Contact Person Information A signed and dated copy of the Agent Authorization letter (a form can be downloaded here: http://www.saw.usace.arm-mil/Portals/59/docs/regulatory/reedocs/Permits/SAMPL E AGENT AUTHORIZATION FORM pdf) must be attached if the Agent has signed this applic tion form. Name: p Company Affiliation: Mailing Address: S? 1 Telephone Number: q63 -W -8K.316 Fax Number: go3- E-mail Address: Person to receive the Certification Approval:da • Project Information [15A NCAC 02H .0502(a) & (b)] • 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. • 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 provided at the end of this application form. • Attach a photograph of the shoreline/ buffer proposed to be stabilized. (Include a scale of some sort- a yard stick, shovel handle, etc.) • Location of the property (where work is to be conducted) County: is, P_ "'.",., Nearest Town: I�W_ l ratio M4 Subdivision name or site address (include phase/lot number): Mc_„ 05 5ow4-h �1ng.-e. arv�on� A.C. 12 Loi FO�n<ltAs1to(,e— + Directions to site - please include road names and numbers, landmarks, etc.: _Armr'""! W - - 1 Q 'gni-O rJ�ar, �f"Ei.1P �V On 63K4 .-Ikn r,ghA- n k i!'a oe T � , r)4 on So��hSho�C,�r. Latitude (in decimal degrees) 35. 01 10. D7 N Lf Longitude (decimal degrees) IT • OZ .10• to/ kd • Describe the existing land use or condition of the site at the time of this application (residential, undeveloped, etc.): tin vcloo e�Q • I Property size (acres): I. Q 4 • Lake/ river/ ocean adjacent to property: (�IcQ 441;k- 2 • Describe proposed work (include discussion as to how hardening of shoreline has been avoided, or why it is necessa ): - / ',,4 4-0'are_,Ips, rle ss • Will work be conducted fro and From water? • Total amount of disturbance (including all excavation, backfill, rip rap, retaining walls, etc.) below the nor al pool lake level/ Normal Water Level in square -feet or acres: f— 10 9� fowo,.rL ��4 P �t+�?l�L�� Si �-1-, t�-d � ,�/o �✓ � �?ol'rrta/ 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 inIsquare feet or acres: ' x //Q ad E ' o f a C C�es.S t'oQ , % ;,4 xe 12. Please describe the vegetatioA above the normal pool lake level/ Normal Water Level and 50 feet ndward to be impacted (number of trees, for instance): AV _17. , tag- 0.0�-t a �v z4h) t,,5 _ 6- muter 3" 1'" Owner/Agent's Signature' [15A NCAC 02H 0502(f)l Date `Agent's signature is valid only if on authorization letter from the owner is provided. 3 J. Lake (At Full Pond/ Normal water Lever o S `6�re I - r Full Fond ► `` Normal Water Level - �\ / . _ — /I(tN Ca /�� Shoreline - _- = 3, C.e✓,( /000 _ � l -- Slid., ]f} tithe Ther"e Please approximately sketch the following information on this plan (provide dimensions for each item, such as 10 ft x 100 ft) *: • All proposed vegetation clearing • Location of rip rap or fill to be placed above the Full Pond/ Normal Water Level elevation • Location of rip rap or fill to be placed below the Full Pond/ Normal Water Level elevation • Location of any proposed structures such as buildings, retaining walls, docks, etc. • Location of any excavation or dredging below the Full Pond/ Normal Water Level elevation M Location of construction access corridors SAMPLE AGENT AUTHORIZATION FORM PROPERTY LEGAL DESCRIPTION: Qp LOT N0. qb PLAN NO .1 J 9'619,PARCEL ID: STREETADDRESS: 105 &oma ��. 3el,ur,N-- r N -C• 2!g-olZ Please print: Property Owner: - -I— f�'lc S c1Q r. Property Owner: The undersigned, registered property owners of the above noted property, do hereby authorize Ila, (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): 5TK /11 2o i Lakes [ :j uv-, S r. ZC.ZL 0 Telephone: 8 z5. 7324 We hereby certify the above information submitted in this application is true and accurate to the best of our knowledge. u orized Signature Authorized Signature Date: -1-.m-/ � Date: 0 AN Mot lot r. y i is �K` a.•„Iy �Y ( ii .. ✓!� �.i vi 11-� _ :, uli 1:! - • � - ` . ✓, " `� ? .�.� �• • �' k,; k � ; s, ' � +' � _ Y v �. i ,.... _ �_ � tii 4� � ., �.4 � Lr _.. _. ,. 1 , _ f ,;� r �! r _ � �� .# 7 r � �� , �' ',' '�,.`. � 1 +F ,i, e� � � 1 �, ;,t . � h �� . � �_ . .� � y ,, ` a a �� e .=;, ..� ,. '�`�''�� . �� .�i ' � '`s'' 1�. .' y',.re. ii'i -,r � �, \ � � � �� e.- '� g °' � n t ;�, �h f lr � f+if � .� :'' f i . + � e. i� .Ylk a .'h,' t1y� 91.99.