20071565 Ver 2_Shoreline Stabilization_20080305

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The following is an abbreviated application form for those applying for a 401 Water Quality
Cerhficatlon to impact FERC (Federal Energy Regulatory Commission] regulated lake shore or
bottom under the U.S. Army Corps of Engineers Permit GP30. This Application cannot be used
for wetland or stream impacts. Please provide seven (7} copies of this application and supporting
information as well as a noa-refundable application fee to the Division of Water Quality of $240.00
for impacts of to lake bottom of less than 1 acre and $570.00 for impacts to lake bottom of greater
or equal to 1 acre. ~ ~ ~ ~'~ _ ~ s lc 5 U ~,
AppUcatiops should be sent to:
Division of Water Quality 401 Oversight/Express Review Permitting
11150 Mail Service Center
Raleigh, NC 27699-1650 p ~,(~ ~ 0 ~ (~
I. Applicant Information v ~/ L~ s~
MAR 5 2008
1. Owner/Applicant Information DENR-WATER QUALITY
~ / WETLANDS AND STQRMWATER RRFWCi~
Name: -~ ~i /~JG' ~ ~ ~G ~ ~f~~'JC ~~'
Mailing Address: `~ ~ ~'~c1 /71 ~~~~
~~~ C~~-~ t9 YL> C_
Telephone Numbe~~~ ~ l `~ -- ~ ~ ~ ~ Fax Number:
~rtr~l-A~C1reSS: ~ C~~f'~-~ ~3G S'c-3 `-?S^~' c~;
2. Agent Information (A signed and dated copy of the Agent Authorization letter must be attached
if the Agent has signatory authority for the owner/applicant.)
Name:
Company Affiliation:
Mailing Address:
Telephone Number: ~ Fax Number:
E-mail Address:
II. Protect Information
Attach a vicinity map clearly showing the location of the property with respect to local landmazks such
as towns, rivers, and roads. Also provide a detailed site plea showing property boundaries and
development plans in relation to surrounding properties. You may use the diagram below to make a
hand sketch of your project. Also, see the example below for guidance. Both the vicinity map and site
plan must include a scale and north arrow. The footprints of all buildings, impervious surfaces, or other
facilities must be included.

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1. Location ~Q ~,
County: .~,~~,'~'"L~' Nearest Town: / 1 ~~ Fjl'~'~'
Subdivision name or site address (include phase/lot number): ~ ~ ~~
Directions to site please include road numbers, landmarks, etc. (This is not necessary if an adequate
vicinity map is included}:
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Z. Describe the existing Iand use or condition of the site at the time of this application:
3. Property size {acres): ~~_ ; c~ ~,~ C-
4. Nearest body of water (stream/river/sound/oceanliake): ~-/+-~ ,'- ; ~ ! k-E=
S. Describe the purpose of the proposed work: ..~ /' c - , C' ~ , ~ ~ ~3 z -? .'
6. List the type of equipment to be used to construct the project: ~fd~:>~->k' ,~~`=/f~~ ~~..r~~. ~~~-~~-~~
7.
$.a.
Amount of impact (including all excavation, backfill, rip rap, retaining walls, etc.) below the
no~n,}ma.l pool latke level in square feet or acres: ~ct~~: ;^-~~n~y:~~~~ .O.~~Y~I~J
Yip. I / 9 s . 4 .. ~ n .. . :e /
Amount of impact (inc
above the normal pool
~g" all clearing, back fill, excavation, rip rap, retaining walls, etc.)
level and SO feet land-ward in square feet or acres:
(//~/~ ~ ~
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8.b. Please describe vegetation above the normal pool lake level and SO feet landward to be impacted
..
(number of trees for instance): ~ ~., -~~,~~~%.,,.,~ ~ ~ ~'~c~ ~~.u ~•-- ti~ ~~~
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itJAgent's Signature Date
signature is valid only if an authorization letter from the applicant is provided.)

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Plaee approad~natdy sle~ch theforowi~8 i,tcrmstian on thes phn
~Na~ pnwide dinat~ions far ~ ~tt~ such As 10 f't. x 7 dt1 ~t~;
~1 ~ tmoPo~d rt~et~lan cfewairt~ tpr~o~ldv dfnraeneio~e~
.~ Looatlbn ai yip rap or ~fll t4 bek placed ebars the !~i Pond rl~atiQn
~~ Loeatlon at rtlp rep or fill tc tie plsce~d beloww the Ftii Road elevetiot~
4~ TM be~ion oaf ~y p~r~p~ssd suuct~,ir~as such a~ b~utlding~, t~alnlr~
wee, dooks~ otc.
6y Ths location of aigr sxycsvatiaR yr drodpiny below the F~ i'~d
clee~ion.
!~ LQ+cApv~ of ~~tvstructtan a+acess ~carridQrs.
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Parcels
9080-01-18- Owner's
PIN: Record Number: 26387
4885.000 Name:
Billing 9550 MCGHEES MILL
City and State: SEMORA NC Tax Map
Address: RD
1 Et 7/100 AC/LT
Description: Sale Year: 106 ZIP:
A/MH
Building
Townships: 104 Acreage: 1.07
Value:
Property Current
142310 Other Buildings: 2952
Value: Value:
Deed Page: 37 Deed Book: 610 Plat
Calculated
Sale value: 1000 1.0674774539 Subno:
Acres:
POINDEXTER JAMES E 8
ANITA C
A23 189
27343
2768
148030
15/97
-999
County GIS
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i~ttp://gis.personcounty.net/ConnectGlS Web/Map/PrintWindow.aspx?Map=http://gis.perso... 2/28/2008

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