20170079 Ver 1_Shoreline Stabilization_20170130

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: 4i ��' Nearest Town: �'�� ��'�_
Subdivision name or site address (include phase/lot number): W e- b
Directions to site - please include road names and numbers, landmarks, etc.:
_Zi
M
Latitude (in decimal degrees),!�0 Longitude (decimal de reesj2?� / 64
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): — 0 vd '01
6. Property size (acres):
7. Lake/ river/ ocean adjacent to property:
1_ -Ke k Of MF. A/
8. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): v^t t
9. Will work be conducted from land? 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, backfill, 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:
12. Please describe the vegetation above the normal pool lake level/ Normal Watr Level and 50
feet landward to be impacted (number of trees, for instance): re-S-Z,.
l� A-1
Owner/Agent's Signature#
�:�. ��" �, /z,. � •s alb
Printed Name
(15A NCAC 02H .0502(f))
'Agent's signature is valid only if an authorization letter from the owner is provided.
Date
FORM: SSGP 10-2013 Page 2 of 3