20161015 Ver 1_Permit_application_package_20161020

Transpartat�on
October 20, 2016
Ms. Donna Hood
North Carolina Dept. of Environmextal Quality
Division of Water Resources
TransporEation Permitting Branch
610 E. Center Ave.
MooresviZle, NC 28115
PAT McCRORY
c�
NICHOLAS J. TENNYSON
5ecnetmy
SUBJECT: Catawba River Buffer Impacts (Lake Hickory), Bridge #91 Repair, Hwy 127,
Catawba/Alexander County
Dear Ms. Hood:
The North Carolina Department of Transportation requests authorization to temporarily impact
Zone 1 and Zone 2 of the Catawba River Buffer to repair and stabilize the end bents of Bridge #91
on Hwy 127. There will be a total of 5347 square feet of temporary impacts to Zone 1 and a total
of 570 square feet of temporary impacts to Zone 2 of the Catawba River Buffer, Lake Hickory.
This office has conducted a GIS and field survey for the project for historical sites and
threatenedlendangered species sites. There are no sites lisYed on the National Register of Historic
Places are locatad i.n the vicinity of the project and the project occur within existing NCDOT right
of way. The federally listed species (USFWS listed dated April 2, 2015) for both Catawba and
Alexander County, the Dwar� flowered Heartleaf (Hexastylis nata�ara)- Threatened and the
Northern Long Eared Bat (NLEB) (Myotis septeratrzonalis)-7.�reatened; addit�onally for Catawba
County, Schweinitz's sunflower {Helianthus schweinatzia)- Endangered and additionally for
Alexander Coun.ty, Bog T�rtle (Glyptemys muhlenbergii).
Natural Heritage Progra�n records doc�ment the neazest Dwarf-flowered Heartleaf location
appro�mately 1.1 south of the propased project areas. The heartleaf is usually found in acidic soils
along bluffs and adjacent slopes, in boggy areas next to strearns and creek heads, and along tb,e
slopes of nearby hillsides and ravines. The project area is a madway with adjacent agricultural
operation. There is no habita.t within the proposed proj ect area and no species were observed during
the site visit. No impact on this species is anticipated. Natural Heritage Program records document
the nearest Schweintiz's sunflower location 19.5 miles southeast of the proposed project area.
Schweuutz's sunflower is found along roadside rights-of-way, maintained power lines and other
utility rights-of-way, edges of thickets and old pastures, clearings and edges of upland oak-pine-
hickory woods and Fied.mont longleaf pine forests, and other sunny or semi-sunny habitats where
disturbances (e.g., mowing, cleari.ng, grazing, blow dawns, stozxns, frequent fire) help create open
or partially open areas £or sunlight. It is into�erant of full shade and excessive competition from
other vegetation. There is limited habitat within the proposed project area; however, no species
were observed during the site visit. No impact on this species is anticipated. h°atural Heritage
Program records document the closes bog turtle approximately 10.8 rniles south. Bog turtle habitat
consists of open, groundwater supplied (spri.ng fed), graminoid dominated wetlands along riparian
corridors or on seepage slopes. These habitats are designated as mountain bogs by the NCNHP,
but they are technically poor, moderate, or rich fens that may be associated with wet pastures and

NC Hwy 127, Bridge #91
October 20, 2016
Fage 2
old drainage ditches that have saturated muddy substrates with open canopies. There is no habitat
within the proposed project area and no species were observed durixi.g the site visit. No impact on
this species is anticipated.
Natural Heritage Program records document the nearest Northern Long Eared Bat location
approximately 21 miles southwest af the proposed project area. During suminer, northern long-
eared bats roost singly or in colonies underneath bark, in cavities, or in crevices of both live and
dead trees. They may also roost in cooler places, like caves and mines. Tree species may be used
based on suitability to retai.n bark or provide cavities or crevices. It has also beexi. found, rarely,
roosting in siructures lilce barns and sheds. Northern long-eared bats spend winter hibernati.ng in
humid caves and mines. Mini.mal roadside tr'ee clearing will be required to provide a temporary
access road. There are no abandoned structures, barns or shed in close vicinity and the closest
listed underground mine, per NHP database is the Sigmon Mine, 0.5 miles south of the project site
There are currently no lrnown hibernaculum or maternity roost trees in Division 12 counties for
NLEB; therefare, the minor trae clearing associated with this DOT proj ect would be exempted from
incidental take under the �d rule. Attached is the U.S. Fish and Wildlife Service {USFWS) NLEB
4(d) Rule streamlined consultation form. Per guidance from USFWS pez-sonnel, concurrence is
granted by citing the following website and a 30 day response period is waived.
ht ://www.fws. ov/asheville�tmis/ ro'ect reviewlNLEB in WNC.htnr�l
I have enclosed a pre-construction notification for a Water Quality Certification #3883 {Ri�arian
Buffer Rules), plan sheets, and a location map relative to the project.
Project information for the 401 Autornated Payment Procedure is as follows:
• Wark order number: 150463-55120005-12B.101811-3348
. TIP#: NA
• 1'roject Category: $240A0 Fee
If you have any questions or concerns please feel free to contact me at [phone]. Thank you
for your tinne and consideration o� this matter.
Sincerely,
Maxk E. Stafford, P.E.
Division Engineer
Twelfth Division
BY: ���' � �"
Trish Beam
Division 12 Environmental Supervisor
Enclo�suxes
cc:
Andrew Henderson, U.S. Fish and Wildlife Service, Asheville Office

oF wa r�
o� pG Office Use Only:
� � � r Corps action ID no. __
ti
�,�, i a `� DWQ proj�ct no.
Form Version 1.3 Dec 10 2008
Pre-Construciion Notification {PCN) Form
A. Auplicant Infarma'on
1. Processing
1 a. Type(s} of approva� sought from the
Corps:
1 b. Specify Nationwide permit (NWP) number:
❑ Secdon 404 Permit ❑ Section 10 Permit
1 c. Has the NWP or GP number been �erified by the Corps?
or General Permit (GP) number:
❑ Yes ❑ No
9d. Type(s) of appro�al sought from the DWQ (check all tf�at apply}:
❑ 40'� Water Qua[ity Certification — Regular ❑ Non-404 Jurisdictional General Pe�rnit
❑ 401 Water Quality Certification — Express � Riparian Buffer Authorization
1e. Is this natification solely for the record For the record o�ly for DWQ 401 For the record only for Corps Permit:
because written approval is not required? Certification:
! ❑ Yes � No ❑ Yes ❑ No
1f. fs payment into a mitigation bank or in-lieu fee program proposed for mitigation � Yes
of impacts? If so, attacl� the acoeptance letter from mitigation bank or in-lieu
fee program.
1g. Is the project located fn any of NC's twenty coastal oounties. If yes, answer 1 h ❑ Yes
below.
7h. Is the project located within a NC DCM Area of En�ironmental Concern (AEC)? I❑ Yes
2. Project Information �
2a. Name of praject:
2b. County:
2c. Nearest municipality 1 town:
2d. Subdivision name:
2e. NCDOT only, T.I.P. or state
project no:
3. Owner Information
3a. Name(s) on Recorded Deed:
3b. Deed Book and Page No.
3c. Responsible Party (for L�C if
applicable):
3d. Street acidress:
3e. City, state, zip:
3f. Telephone no.:
3g. Fax no.:
3h. Email address:
Bridge #91 Endbent Repairs Repairs, Mighway 127
Catawba/Alexander
Hickory
126.101811
NC DOT Right of Way
►� .
�� .
►1 .
Page 1 qf 11
PCN Farm — Version 1,3 Decernber � 0, 2008 Version

4. Applicant Information [if different from owner)
4a. Applicant is: ❑ Agent ❑ Othar, specify:
4b Name� Mark E. Stafford
4c. Business name
4d. Street address:
4e. City, state, zip:
4f. Selephone no.:
4g. Fax no.:
fV.C. Department of Transportation, DNision 12
1710 East Marion Street
Shelby, NC 28151
7Q4-�480-902U
704-480-5401
�4h. Email address: I [e-mail]
5. AgentlConsuliant Information (if applicable}
5a. Mame: Trish Beam
5b. Business name
(if applicable):
5c. Street address:
5d. City, s#ate, zip:
5e. Telephone no.:
5f. Fax no.:
5g. Email address:
N.C. �epartment of Transportation, Di�ision 12
� 710 East Marion Street
Shelby, NC 28151
704-48D-9044
704-4$0-54D1
[e-mail]
Page 2 of 11
PCN Form — Version �.3 December 10, 20a8 Uersion

B. Project Enformation and Prior Project History
'I. Property Identificatlon
1a. Property identification no. (tax PIN or parcel ID): NA
� Latitude: 35.80142 Longitude: - 81.30474
1b. Site coordinates (in decimal degrees):
(DD.DDDDDD) (-bD.DD�DDD)
'i c. Property size: 0.019 acres
2. Surtace Waters
2a. Name of nearest body of water (stream, rir►er, etc.) to Lake Hickory, Catawba River
proposed project:
2b. Water Quality Classification of nearest receiving water: W5-IV & B CA
2c. River basin: Catawba
3. Project oescription
3a. Describe the existing conditions on the site and the general land use in the �icinity of the project at the time of this
application:
Existing bridge. Surrounding landuse designation is forested and residential.
3b. List the total estimated acreage of all existing w�tlands on the properly:
0
3c. List tF�e total estima#ed linear feet of all existing streams (intermitkent and perennial) on the property:
100 feet
3d. Explain the purpose of the propased project:
The purpose of the proposed work is to repair bridge at endbent #1 and #2.
3e. Describe the o�erall project in detail, including the type of equipment to be used:
The North Carolina Department of Transportation proposes to make repairs to Sridge #91 o�er Lake Hickory by
constructing an cast in place in#egral curiain wall on existing bench caps, i�ialla6on of soil nail walls and ground anchors,
and installation of interceptor drain and pavement repair. An Interceptor drain is a subsurtace drain that runs under the
bridge approaches tv collect water underneath the pavement and pre�ent it from collecting around the end bents. These
drains will be set back at least 30' from the bridge which wil� be outside the 50' buffer zone. Any water that is collected by
these drains will drain into the existing ditch lines prior to entering the buffer zones.
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property 1
project (including ail prior phases) in the past? ❑ Yes � No ❑ Unknown
Comments: Jurisdickional stream determination made by
Di�ision 12 DEO.
4b. If the Corps made the jurisdictional determination, what type
of determination was made? ❑ Preliminary ❑ Final
4c. Ef yes, who cieli�eated the jurisdictional areas? AgencylCansultant Company:
Name (if known): Other:
4d. {f yes, list the dates of the Corps jurisdietional determinations or State determinations and attach documentatian,
5. Praject History
5a. Have permits or certifications been requested or obtained for � Yes � No ❑ Unknown
t�is project (including all prior phases) in the past7
5b. Ef yes, expfain in detail according to `help file" instructions.
Page 3 of 19
PCN Form — Version 1.3 December 10, 2008 Version

6. Future Project Flans
6a. Is this a phased project? ❑ Yes � No
6b. If yes, explain.
Page 4 of 11
PCN Form — Versian 1.3 December 10, 2008 Version

C. Proposed Impacts Inventory
1. Impacts Summary
1 a. Which sections were completed below far your praject {check all that apply):
❑ Wetlands ❑ Streams - tributaries � BufFers
❑ Open Waters ❑ Pond Construction
2. Wetland Impacts
If there are wetland impacts proposed on the site, then complete this question for ea�h wetland a�ea ir�pacted.
2a. 2b. 2c. 2d. 2e. 2f.
Wetland impact Type of jurisdiction
number — Type of impact Type of wetland Forested (Corps - 4d4, 10 Area of impact
Permanent (P} or (if known) DWQ — non-404, other) {acres)
Tem ora T
W 1❑ P � T ❑ Yes ❑ Corps
❑ No ❑ DWQ
W2 � P � T �I❑ Yes ❑ Corps
! ❑ No ❑ DWQ
W3 ❑ P❑ T ❑ Yes ❑ Corps
❑ Nv ❑ DWQ
W4 ❑ P❑ T ❑ Yes ❑ Corps
❑ No ❑ DWQ
W� � P� T ❑ Yes ❑ Corps
❑ No ❑ DWQ
W6 ❑ P❑ T ❑ Yes ❑ Corps
❑ No ❑ DWQ
2g. Total wetland impacts
2h. Comments:
3. Strearr� lmpacts
If there are perennial ar intermittent stream impacts (including temporary impacts) proposed on the site, then complete this
question for all stream sites impacted.
3a. 3b. 3c. 3d. 3e. 3f. 3g.
5tream irr�pact Type af impact Stream name Perennial Type ofjurisdiction Average Impact
number - (PER} or (Corps - 404, 10 stream length
Permanent (P) or intermittent DWQ — non-404, widkh (linear
Temporary {T) (INT}? other) (feet) feet)
S'E ❑P❑T ❑PER ❑Corps
❑INT ❑DWQ
52 ❑P❑T ❑PER ❑Corps
❑ INT ❑ DWQ
S3 ❑ P❑ T ❑ PER ❑ Corps
❑ INT �] DWQ
S4 ❑ P❑ T ❑ P�R ❑ Corps
❑ INT ❑ DWQ
S6 ❑ P � T ❑ PER ❑ Corps
❑ INT ❑ DWQ
S6 ❑ P❑ T ❑ PER ❑ Corps
❑ INT ❑ DWQ
3h. Total stream and tributary impacta
3i. Comments: J � �
Page 5 of 11
PCN Form — Version 1.3 Decernber 10, 2008 Version

4. Open Water Empacts
If there are proposed impacts to lakes, ponds, estuaries, tributaries, sounds, the Atlantic Ocean, or any other open water of
the U.S. then individually list ail open water impacts below.
4a. 4b. 4c. 4d. 4e.
Open water Name of waterbody
impact number (if applicable) Type o# impact Waterbody type Area of impact (acres)
— Permanent
(P) or
Tem ora T
01 ❑POT
02 ❑P�T
03 ❑P❑T
04 ❑P❑T
4f. Total open water imp�cts
�4g. Comments:
5. Pond ar Lake Constructio�
If ond or lake construetion ro osed, then com lete the chart below.
5a. Sb. 6c. 5d. 5e.
Wetland Impacts {acres) Stream lmpacts (feet} Upland
Pond ID Proposed use or purpose of (acres)
number pond
Flooded Filled Excavated Ffooded Filled Exca�ated Flooded
f�1
P2
5f. Total
5g. Comments:
5h. Is a dam high hazard permit required?
❑ Yes ❑ Mo If yes, permit ID no:
5i. Expected pond surface area (acres):
53. Size of pond watershed (acres):
5k. Method of constru�tion:
Page 6 of 11
PCN Form — Version 1.3 December 10, 2008 Version

6. Buffer tmpacts (for DWQj
If project will impact a protected riparian buffer, then complete the ehart below. If yes, then individually list all buffer impacts
below. If an im acts re uire miti ation, tfien ou MlJST fill out Section D of tf�is form.
6a.
❑ Neuse ❑ Tar-Pamlica ❑ Other:
Project is in which protected basin? ❑ Catawba ❑ Randleman
6b. 6c. 6d. i 6e. 6f. 6g.
Buffer impact !
number — Reason for � Buffer Zone 1 impact Zone 2 impaet
Permanent (P) impact Stream name mitigation (square feet) (square feet)
or Temporary required7
T
Temporary South end (bent �) South end (bent 9)_
B1 ❑ P� T Access Lake Hickory (Catawba ❑ Yes = 160Q; EVorth end 27d; North end (bent 2
Road Ri�er) � No (bent 2= 1956 = 200
Temporary
Riprap for South end (bent t)
B2 ❑ P� T Construction �ke Hickory (Catawba �❑ Yes = 7g4; I�orth end 0
Staging R9�er) � No (bent 2= 697
Area
Temporary
Erosion Saut#� end (bent 1) South end (bent 1) 50 =
B3 ❑ P� T Control �ke Hickory (Catawba ❑ Yes 150 =; Norfh end ; North end (bent 2=
Measure{5ilt Ri�er) � No (bent 2=�50 50
fence)
Temp. Access
Rvad = 3556;
Temp. Riprap Temp. Access Road =
6h. Total buffer impacfa Staging Area = 470; Temp. EroSion
1481; Temp. Control = 100
Erosion Control =
300
6f. Camments:
D. Impact Justification and Mitigation
1. Avoidance and Minimization
1a. Specificafly describe measures ta�Cen to avaitE or minimize khe proposed impacts in designing project.
1 b. Specifically describe measures taken to avaid or minimize the proposed impacts through construction techniques.
Areas disturbed for temporary access road and riprap construction staging area under bridge will be seededlstabilized.
Vegetation will be restored within 6 months of initial disturbance.
2. Compensatory Mitigation for lmpacts to Waters of tf�e U.S. or Waters of the State
2a. Does the project require Compensatary Mitigation for ❑ Yes � No
i�npacts #o Waters of the U.S. or Waters of the State?
2b. If yes, mitigation is required by (check all that apply): ❑ DWQ ❑ CorpS
❑ Mitigation bank
2c. If yes, which mitigation option will be used for this project? ❑ Payment to in-lieu fee program
❑ Permittee Responsible Mitigation
Page 7 of 11
PCN Form — Version 1.3 December 10, 2a08 Version

3. Complete if Using a Mitigation Bank
3a. Name of Mitigation Bank:
3b. Credits Purchased (attach receipt and letter) Type Quankity
3c. Comments:
4. Complete if Making a Payment ta In-lieu Fee Program
4a. Approval letter from in-lieu fee program is attached. ❑ Yes
4b. Stream mitigation req�ested: linear feet
4c. If using stream mitigation, stream temperature: ❑ warm ❑ cool ❑cold
4d. Buffer mitigation requested (DWQ only}: square feet
4e. Riparian wetland mitigation requested: acres
4f. Non-riparian wetland mitigation requested: acres
4g. Coastal (tidal) wetland mitigation requesked: acres
4h. Cornments:
5, Complete if Using a Permittes Responsible Mitigation Plan
5a. If using a permittee responsible mitigation plan, pro�ide a description of the proposed mitigation plan.
8, Buffer Mitigation (5tate Regulated REparian Buffer Rules) — required by DWQ
6a. Will the project result in an impact within a protected riparian buffer that requires ❑ Yes � No
buffer mitigation?
6b. If yes, then identify the square feet of impact to each zone of the riparian bufFer that requires mitigation. Calculate the
amount of mitigation required.
6c. 6d. Be.
Zone Reason for impact Total impact Multiplier Required mitigation
(square feet) (square feet)
zone 1 3(2 far Catawba)
Zone 2 1.5
6f. Total bufFer mitigation required:
6g. If buffer mitigation is required, discuss what type of mitigation is proposed (e.g., payment to pri�ake mitigakion bank,
permittee respansible riparian buffer restoration, payment into an approved in-lieu fee fund).
6h. Comments:
Page8of11
PCN Form — Version 1.3 December 10, 20fl8 Version

E. Stormwater Management and Diffuse Flnw Plan (required by DWQ)
1. Diffusa Flow Plan
� 1a. Does the project incl�de or is it adjacent to protected riparian buffers identified
. within one of the NC Riparian Buffer Protection Rules?
1 b. If yes, then is a diffuse flow plan included? If no, exp{ain why.
Comments: Ternporary impacts
2. Stormwater Mana ement Plan
2a. What is the overall percent imperviousness of this project?
� Yes ❑ No
❑ Yes � No
0%
2b. Does this project require a Stormwater Management Plan? ❑ Yes � No
2c. If this project DOES NQT require a 5tormwater Managerr�ent Plan, explain why: Bridge repair
2d. If this project DOES require a Stormwater Management Plan, then provide a brief, narrati�e description of the plar�:
2e. Who will be responsible ior the re�iew of the Stormwater Management Pian?
3. Certified Locat Ga�ernment Stormwater Review
3a. In which local go�ernment's jurisdiction is this project?
3b. Which of the following locally-implemented stormwater management programs
apply (check all that apply):
3c. Has the appro�ed 5tormwater Management Plan with proof of appro�al been
attached?
4. DWQ Stormwater Pro�ram Review
�4a. Which of the following state-implemented stormwater management programs apply
(check all that apply):
4b. Has the approved Stormwater Management Plan with proof of approval been
attached?
5. DWQ 401 Unit Stormwater Review
5a. Does the Stormwater Management Plan meet the appropriate requirements?
5b. Have all of the 401 Unit submittal requirements been met?
❑ Certified Local Govern�nent
❑ DWQ 5tormwater Program
� DWQ 401 Unit
NA
❑ Phase II
❑ NSW
❑ USMP
❑ Water Supply Watershed
❑ Other:
❑ Yes ❑ No
❑ Coastal counties
❑ HQW
❑ ORW
❑ Session Law 2006-246
❑ Other:
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Page 9 of 11
PCN Form — Version 1.3 December 10, 2008 Version

F. Supplemeniary Information
1. En�ironmental Documentation (DWQ Requirement)
1 a. Does the project invol�e an expenditure of public (federallstatelVocal) funds or the � Yes ❑ No
use of public {federallstate) land?
1 b. If you answered "yesp to the abo�e, does the project requira preparation of an
en�ironmental document pursuant to the requirements of the National or Siate ❑ Yes � No
(North Carolina) En�ironmental Policy Act {MEPAISEPA)?
1c. If you answered "yes" to the abo�e, has the document re�iew been finalized by the
State Clearing House? (If so, attach a copy of the IVEPA or SEPA final approval
letter.) ❑ Yes ❑ No
Comments:
2. Violations (DWQ Requirementj
2a. Is the site in violation of DWQ Wetland Ruies (15A NCAC 2H .0500), Isolated
Wetland Rules (15A NCAC 2H .1300), DWQ SurFace Water or Wetland Standards, ❑ Yes � No
or Riparian Buffer Rules (15A NCAC 2B .0200)?
2b. Is this an after-the-fact permit application? ❑ Yes � No
2c. If you answered "yes" to one or both of the abo�e questions, provide an expianation of the violation{s):
3. Cumulative Impacts {pWQ Requirementj
3a. Will this project {based on past and reasonably anticipated future impacts) result in � Yes � No
additional de�elopment, which could impact nearby downstream water quality?
3b. If you answered "yes" to the above, submit a qualitative or quantitatir►e cumulative impact analysis in a�cordance with the
most recent DWQ policy. If you answered "no," provide a short narrati�e description.
The project is a minimum criteria groject which has low potential for cumulati�elindirect impacts and will nat result in
additional de�elapmenk which could impact water quality.
4. Sewage Disposal (DWQ Requirement}
4a. Clearly detail the ultimate treatment methods and disposition (non-discharge or discharge) of wastewater generated from
the proposed project, or available capacity of the subject facility.
No wastewaker is generated from praject.
Page 10 of 11
PCN Form — Version 1.3 December 10, 2008 Version

5. Endangered Species and Designated Critical Habitat (Corps Requirement)
5a. Will this project occur in or near an area with federally protected species or
habitat? � ❑ Yes � No
5b. Have yo� checked with the U5FV1lS conceming Endangered Species Act �� Yes ❑ No
impacts .
❑ Raleigh
5c. If yes, indicate the USFWS Field Office you have contacted.
� AsheviEle
5d. What data sources did you use to determine whether your site would impact Endangered Species or besignated Critical
Habi#at?
NC Natural Heritage Program database and onsite surveys.
6. Essentiai Fish Habitat (Corps Requirement)
6a. Will t�is project occur in or near an area designated as essen#ial fish habitai? ❑ Yes � No
6b. What data sources did you use to determine whether your sEte would impact EssentiaE Fish Habitat?
Na salt marshes, oyster reefs, or seagrass beds locateci in vicinity of project.
� 7. Historic or Prehistoric Cultural Resources (Corps Reauirementa
7a. Will this praject occur in or near an area that the state, federal or tribal �
go�ernments ha�e designated as having historic or cultura! preservation � Yes � No
status (e.g., Natianal Historic 7rust �esignation or properties significant in
North Carolina history and archaeology)?
7b. What data sources did you use io determine whether your site would impact historic or archeoEogical resources?
Culiural Resources reviaw, no known sites in vicinity and project disturbance is within NCDOT ROW.
8. Flaod Zone Designation (Corps Requirement)
� 8a. Will this project occur in a FEMA-designated 100-year floodplain? � Yes ❑ No
� Sb. If yes, explain how project meets FEMA requirements: Temporary impacts to Zone AE, which is an area inundated by 1%
E annual chance flooding, for which BF�s (base filood elevations) ha�e been determined. Upon completion, project will be
seededlstabilzed and returned to pre project conditions.
Sc. What source{s} did you use to make the floodplain determination? http:llfris.nc.govl
I
� ,��IC � , �
/� ��'' � �`� �_ �� -a��-��
�
` ApplicantlAgent's Printed Name ApplicantlAgen' gnature Date
� (Agent's signature is valid only if an authorization letter from the applicant
is ro�ided.
Page 11 of 11
PCN Form — Version 1.3 Decernber 10, 2Q08 Version

Bridge #9� Replair
Hwy 127
CatawbalAlexander County
Vicinity Map
N
0 0.5 1 2 Miles
I i i i! E i i I