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Home My WebLink About20160355 Ver 1_Shoreline Stabilization_20160411Agent Authorization Form PROPERTY LEGAL DESCRIPTION: PAID LOT NO. 1 PLAN NO. PARCELD: STREET ADDRESS : w Please print Property Owner: <—1 20160355 Property Owner: The undersigned, regiproperty owners of the above noted property, do hereby authorize r�'1Cj ,of % (Contractor / Agent) (Name of consulting firm) toacton my behalf and take all actions necessary forthe processing, issuance and this permit or certification and any and all standard and special conditions attached. Property OwneesAddressj#Agerentthan property above): Telephone: We hereby certify the above information submitted in this application is true and accurate to the bestof our knowledge. Authorized Signature Authorized Signature Date: 10 Date: L1 1 -d 1 1 2016 r NMI Division of Water Resources State of North Carolina Department of Environment and Natural Resources Division of Water Resources 15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization FORM: SSGP 10-2013 Shoreline Stabilization Application Form Four copies of the application (including attachments) and the application fee should be sent to: 1. Division of Water Resources 401 & Buffer Permitting Unit 1650 Mail Service Center Raleigh, NC 27699-1650 Applicant Information [15A NCAC 02H .0502(a) Owner Information Name: Mailing Telephone Number: Fax Number: E-mail Address: 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.army.mil/Portals/59/docs/regulatory/regdocs/Permits/SAMPLE AGENT AUTH ORIZATION FORM. df) must be attached if the Agent has signed this application form. Name: me, Company Affiliation: ' Mailing Address: LAle- Telephone Number:`W1$_ •�1�3 J Fax Number: •i&� 1 • b(� L_l E-mail Address: \A.%m Q dpU/% rc-m(--AtAcr Ori V\r,e, - Cov-y-, Person to receive the Certification Approval: t- m e_ 11. Project Information 1`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, FORM: SSGP 10-2013 Page 1 of 4 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. 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: Nearest Town: Q.)C-NV-t,4O4E- Subdivision name or site address (include phase/lot number): 1�a�141 Rh.c�eti�� `,8 Directions to site - please include road names and numbers, landmarks, etc.:c�l�_ 5. Describe the existing land use or�condition of the site at the time of this application (residential, undeveloped, etc.): 6. Property size (acres): i . 5 7. Lake/ river/ ocean adjacent to property: \.0 8. Describe proposed work (include discussiog as to how hardening of shoreline has been avoided, or why it is necessary): _;;,CV� nS ��t k_t L ro-�_ C-Nk fQ , 9. Will work be conducted from land? ❑ From water? Q/ 10. Total amount of disturbance (including all excavation, backfill, rip rap, retaining walls, etc.) below the normal pool lake level/ Normal W er Level in square feet or acres: 11. Total amount of disturbance (including all clearing, back fill, excavation, rip rap, retaining walls, etc.) above the normal pool lake level/ Normal Water Le el and 50 feet land -ward in square feet or acres: tic� 12. Please describe the vegetation above the normal pool lake level/ Nil al Water Level and 50 feet landward to be impacted ( mber of trees, tqr instan e): \ Owner/Agent's Signature* [15A NCAC 02H .0502(f)] Date Agent's signature is valid only if an authorization letter from the owner is provided. FORM: SSGP 10-2013 Page 2 of 3 F Norm< S La ke (At Full Pond/ Normal Water Level) Please approximately sketch the following information on this plan (provide dimensions for each item, such as loft x 100 ft)*: 1. All proposed vegetation clearing 2. Location of rip rap or fill to be placed above the Full Pond/ Normal Water Level elevation 3. Location of rip rap or fill to be placed below the Full Pond/ Normal Water Level elevation 4. Location of any proposed structures such as buildings, retaining walls, docks, etc. 5. Location of any excavation or dredging below the Full Pond/ Normal Water Level elevation 6. Loc ion of construction access corridors 11 ��oSe.c� V �� -�r; o�c-� cAe,�..� Nom. s rc FORM: SSGP 10-20 3 Page 3 of 3 4/6/2016 15941 Rhinehill Rd - Google Maps Go gle Maps 15941 Rhinehill Rd •1L Irk 15941 Rhinehill Rd Charlotte, NC 28278 -41 -n dl RA Map data @2016 Google 1000 ft https://www.google.com/maps/pl ace/15941 +Rhi nehi I I+Rd,+Charlotte,+NC+28278/@35.0834485,-81.0483957,15z/data=!4m2!3m 1! 1 sOx885691 b6bl23e235:Ox21... 1/2 y1 "C.ji'l� a —•��r .I • I Y.�{��",�,, -��` •, i -_ p`� •tet � , RI ,, � _ . �.�. , h � `�e s'.. a"' `� •ice � 1J�L� '� �� '. j ��a r ` 1 } `' _„a'•+T l� �x•Ir X '� M�� 4Y r Ki.V„�y�+��•'�? � � i �,� , as�J � err ,' t `„ ��' ,pl�•' � ? y vY -`' �,�� '�`,'Ye TH'S S. TO CERTIFY THAT ON THE ',___DAY OF S,,-iow;q ON THIS PLAT AND THAT THE TITLE -!NES AF LOT 13 T's '9p CE , J j Z, -JRVEYED THE PRO' -ER,, -Y -.E WALLS'OF THE 'LIUILDINGS 17 ANY ARE REGIS"RED S'JRVrYOR 7 1163 cG 'v, ,.r4 14) V\ 77�-- WYLIE L S S19 19 - .—SURVEY OT LOT [ON 42 7 14 S LOT I S T 1 LAKE WYLI�E� R�E( ATION LOTS ATT�_ �� j=RG S c� c- S.CALZ THE PROPERTY OF 'v, 77�-- L S S19 19 - .—SURVEY OT LOT [ON 42 7 14 S LOT I S T 1 LAKE WYLI�E� R�E( ATION LOTS ATT�_ �� j=RG S c� c- S.CALZ THE PROPERTY OF MAP RECORDED IN BOOK /9 AT PAGE =ED RECORDED IN BOOK PAGF.