20160793 Ver 1_Shoreline Stabilization_20160816

PAID 0 160
$.SAMP AUTHORIZATION FORM 3
PROPERTY LEGAL DESCRIPTION: j� a//�
LOT NO. PLAN NO. PARCEL ID: &k .M cl l
_fjyQ7
STREET ADDRESS:
Property Owner: n-PN-,,,�Aj
The undersigned, registered property owners of the above noted properly, do hereby authorize
i
Of ,s/�'�t5 �1 ✓int r6q.SfrK� I QyL--
(Contra r Agent) (Name of consulting firm) I
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: % �-
AUG 16 2015
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
Authorized9Signature
Date: j D. v
r

i
Shoreline Stabilization Application Form
Three copies of the application (including attachments) and the application fee
should be sent to:
Division of Water Resources
401 & Buffer Permitting Unit
1617 Mail Service Center
Raleigh, IVC 27699-1617
o Applicant information [15A NCAC 02H .0502(a)]
1. Owner Info mation
Name:
Mailing Address: Za4 ),P -r
e� 6- 02 0/
F
Telephone Number: %Y-?'13'S"S)'3%Fax Number:
i
E-mail Address: o. -t ,p C S. C 0)*'t
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/SAMPL
E AGENT AUTHORIZATION FORM.pdt) must be attached if the Agent has signed
this application form_
Name: 6VI4/ �Gt,[,✓S .r���
Company Affiliation:S (�z5t ilG7L'/dam
Mailing Address: 5��5 t��e .S t4
La. kms-

Telephone Number: 03-531- V31 40
E-mail Address:
Fax Number:
re, (&U)S '?S,m e t fk6" - n r- f
Person to receive the Certification Approval: C444,1-5at__
® Project Information [15A NCAC 02H .0502(a) & (b)]
o 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.
o 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: 6 4.St&_% Nearest Town: &/M f '
Subdivision name or site address (include phase/lot number):
P.J AP ,373 / D,,-,_ � �/D7 // V
Directions to site - please include road names and numbers, landmarks, etc.:
'XK�Jfe _d&
Latitude (in decimal degrees)Longitude (decimal degrees) a,
„U)
O Describe the existing land use or condition of the site at the time of this
application (residential, undeveloped, etc.): C
® Property size (acres): Z Q e��
® Lake/ river/ ocean adjacent to property:
2

® Describe proposed work (include discussion as to how hardening of shoreline
has been avoided, or why it is necessary): mi`wj'fk
1
14 )a lLQ L ,',,.� 0 ;L 14 Lc/Q ��r t'S /`'•- C f! 2- Pel . S 4,0Cf l; 4e
Coves 4Jke-r-e--doeW fo lee ctt'faarle,�—
• Will work be conducted from land? Y S From water?
® Total amount of disturbance (including all excavation, backfill, rip rap,
retaining walls, etc.) below the rjormal pool lake level/ Normal Water Level in
square feet or acres:' ),.
I
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 in square feet or acres: V/_fi rYlaX
12. 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): %1% tYg—zs nf,r 14 ±,Q Ar— Ce4efpd/eek
u Ko(.ir .brufGc,_ _5,4
m r�
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.
3

j :.,
Home insert Design _n1M3c0n5 Shde Sha:
J
Reset
i3�t_
_ - chd,- .,J Delate —
=t
I"1
Full Pond
Normal Water_Level
Shoreline
5htle4at4 Office Theme'
•.la Laserfizhe
Lake
(At Full Pond/Normal Waterl-evel)
�loCMaal
ptou. j—
r , 1 XV
;y°� 3 tO ,
9,3
_ - -- _ - - - fol CL
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/ Formal 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
0

® Location of construction access corridors

THIS IS TO CERTIFY THAT ON THE _8 —DAY OF- DEC. __ 2004 _ AN ACTUAL
SURVEY WAS MADE UNDER MY SUPERVISION OF 7HE PROPERTY SHOWN ON THIS PLAT, AND THAT THE BOUNDARY LINES
AND THE IMPROVEMENTS; IF ANY, ARE AS SHOWN HEREON. THIS PLAT MEETS THE MIN/MUM STANDARDS OF PRAC77CE
FOR LAND SURVEMNG IN NORTH G4ROLINA, BOARD RULE .1600 (21 NC40 56) AND THE ERROR OF CLOSURE FOR THIS
PARCEL DOES NOT EXCEED ONE (1) FOOT PER !O, 000 FEET OF PERIMETER SURVEYED NOR 20 SECONDS 77RES THE
SOUARE ROOT OF THE NUMBER OF ANGLES TURNED. (r " , ( l-, . r +
j1 rX S/TE
X
LOWER
ARMSTONG
RD.
SIGNED
Dowd { Oickspn, PA
JW5 S. IPE RD.,*
28056-
(764)
Z4 REBAR eAKE
V/CIVTY MAP shy
NOT TO SCALEO ' ;� \ \ �r
R
E.
LARRY & JUDY GADO/S
D. B. 28,37-834
134RE-SAIFLQ
�o
o
114 REBAR
n /
J
'y, +o
/
/
Z4 RE, 5A
I LOT 2 3
VACANT I
30' SE734CK TO
,�4 RE, 9A
Elio,
TOTE.•
he survey which resU/ted in this
l -at Used only the record /nformat/on
•oted hereon and makes no certifi-
at/on as tO tit/d- or Ownership of
ny parcels shown. Other documents
gay exist that Would affect these
arcels. Declaration is made to the
rigln7& purchaser of e survey. /s
urvey /s not transferable to additional-
7st/tubons or owners and /s
WYLIE
#4R, BAR X'S '
eq
V
S .34° 77' DO" W
LOWER ARMSTRONG ROAD
AREA Y BDMD
J6,287 S. F.
OR
0.8.330 ACRES
rya/id without on ono/no/ emboss. SURVEY OF-
LOT
FLOT 2, SARA M. LEEPER PROPERTY
SOUTHPO/NT TOWNSH Y, N
/P, GASTON COUNTC.
rHE PROPERTY OF
SCALE 1 »=50
MAP BOOK PAGE
DEED BOOK 954 p c - 672
TAX CODE' 15-106-2.01
DONNA 0EN7-01V
FL 00D CERT/F/CAT/ON
THIS IS 7V CERR-Y THAT THE SUBJECT PROPERTY ADJOINS
1OC47F9 IN A SPEC14L 4L000 HAL4RO AREA AS SHOWN ON
MAPS PREPARED BY 7HE fEDER4L EMERGENCY MANAGEMENT
AGENCY, FEDERAL INSUR4NCE ADMINIS7RA770N,
3707100316E D41F9 3-03-2003
,f COMP. No.
7476 HD2

880 Lower Armstrong Rd, Belmont, NC 28012 - MapQuest
Search Results for "88o Lower
Armstrong Rd, Belmont, NC 28012"
page 1 of 1
Q 1. 880 Lower Armstrong Rd
880 Lower Armstrong Rd,
Belmont, IVC 28012
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Page l of 2
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https://www.mapquest.com/search/results?slug=%2Fus%2Fnc%2Fbelmont%2F28012%2... 8/12/2016

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