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Home My WebLink About20160426 Ver 1_Shoreline Stabilization_20160502State of North Carolina Department of Environment and Natural Resources DWR Division of Water Resources Division of Water Resources 15A NCAC 02H.0500 — Water Quality Certification, Shoreline Stabilization FORM: SSGP 10.2013 Shoreline Stabilization Application Form Three copies of the application (including attachments) and the plWIon fee should be sent to: - P Division of Water Resources AID 401 & Buffer Permitting Unit 1617 Mail Service Center �S Raleigh, NC 27699-1617 ` 0 e Q Q j� 4 2 e iSto 1. Applicant Information [: __ �,1. Owner Information Name: 11� 4 tr- L a� 9EQ'E OURC Mailing Address: ► � ; r, -, ) L -k -1 !'� r �' }; �C FFER PERMIT? r�,�Le�yi Y) C �L"l Gsl Telephone Number: `Jy5i 7 ec - �i 41V Fax Number: E-mail Address: 'h,11.0 : ter^ 1)0 J- 6;ya 2. Agent/ Contact Person InTornhation A signed and dated copy of the Agent Authorization letter (a form can be downloaded here: must be attached if the Agent has signed this application form. Name: _tom, f• �L.t ►, .- Company Affiliation: _ A l� ; )'5 W L , '�T_ ,, S7 _ CZZc / Mailing Address: Telephone Number: E-mail Address: -1 i; x Ems_ Fax Number: — /) _. Person to receive the Certification Approval: I1. Project Information [: iA +v<<faC_)2- ' 05� _-;., S� yhlj 41. 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 3 i"hta • k pj� EXAMPLE AGENT AUTHORIZATION FORM Property Legal Description: Parcel ID: Lot No. (if applicable) ,(1„��' Plan No. (if applicable) Street Address (if applicable): ay Property Owner. Owner Name (print): Property Owner's Address (if different than the above): tl:zA A iu 1�a L j?:j Ral�jg ►� n c•. � � w�� Owner Signature: 'f 12 -2 -/z -Cl The above registered property owners of the above property, do hereby authorize I/,/ ckallz Of PA;t,5 ayah'z� Agent Name Agent Company Name (if applicable) to act on my behalf and take all actions necessary for the application, processing, issuance and acceptance of this permit, certification or authorization including all standard and special conditions attached. I hereby certify that the above information submitted on this form and application is true and accurate to the best of my knowledge. Authorized Agent Name / Company: q&,, Authorized Agent Signature: Date: 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.) 4. Location of the property (where work is to be conducted) County: ICE �,,\" k I-. r Nearest Town: j; c'-wn Subdivision name or site address (include phase/lot number): Directions to site - please include road rimes and numbers, landmarks, etc.: t=r n1 B -,,,, .LIUT�tLr �'h�n J�i3� ` rti �Lri1., eq(l r. -rt- A l,t 7aJr.. t; • r ► 'L es T'v 1 144. (►n decimal degrees). Longitude (decimal degrees) __= 5. Describe the existing land use or condition of the site at the time of this application (residential, undeveloped, etc.): j ( c 1 c' 6. Property size (acres): 7. Lake/ river/ ocean adjacent to property: L. k, ,)�c ,r �( •' 8. Describe proposed work (include discussion as to how hardening of shoreline has been avoided, or why it is necessary): T/cn ►.,D t., * h ,, }, 9. Will work be conducted from land? 2 From water? ❑ 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: 11. Total amount of disturbance (including all clearing, back fill, excavation, rip rap, rftaming.__ walls, etc.) above the normal pool lake level/ Normal Water Level and 50 feet land -ward in square feet or acres: ! ;l D 5 �c f . t -irv& e 12. Please describe the vegetation above the normal pool lake level/ Normal Water Level and 50 feet landward to be omnarted !number of trees, for instance): .<-7,)A)1.1- c7 P,,.,.i/3. (�, 9) �;' 0.,..L i,.•. - its_- _.J pama9-�d Owner/Agent's Signature(1,n. r.;.r��: J41h',�,5-o�.0,, Date �dnont'c cinnntr►ry is vnlW nnhi if nn mehnri7ntinn Inftor frnm thv nwnvr is nrwi4Ad FORM: Y ..... SSCP10-2013 ,...r y ............_............... �..... ...........�.._ r• � ...... Page 2 of 3 l \V su�ci�u� 3�j tN'10- S� l4K4 RoYaI,"'a J -- of-� off! T . - 5" 1Aer` o h � q'm Lake RGA d 14 (At Full Pond/ Normal Water Level) Full Pond/ Lx Normal Water Level i it i r it Shoreline ► kLk4:;4 a&a�,► i� u'"o� 3 yl I L_o'j�klo69 Hs Please approximately sketch the following information on this plan (provide dimensions for each item, such as loft x 1oo ft)*: 1. All proposed vegetation clearing -5 r, t_; 2. Location of rip rap or fill to be placed above the Full Pond/ Normal _ ater Leyel elevation 3!� 3. Location of rip rap or fill to-be_placed_below_the Full Pond/ Normal Water Level_elev_ation O 4. Location of any Proposed,structures such as buildings inin wa s docks, etc. S. Location of any excavation or dredging below the Full Pond/ Normal Water Level elevation t= r 6. Location of construction access corridors FORM: SSGP 10-2013 Page 3 of 3 sl ac \' Y.r �•'LL �^rl. 1 r 1 ,r!S i { , f,j�' � � ,. ��• / i fix/ � ?. ', i �,► y .. jam= . }y,i•Sp'j, y+� ,,,�':( � .. i � r'1�:�+`.N��I4 '�( ..' �. '" �.,y, 1li , ;� St •, 7` \ •` �`. ,f," \ �. ��. yet ,�u• ( .'('/ /Pe J, r. r l ,*,, 1 .FIs �l 1, �� 1•, (a.i,t'�': lj� .� `% � /� l'� : � ,. 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