20170352 Ver 1_Bridge 99 Yancey cover sheet_20170328

Corps Submittal Cover Sheet
Please provide the following info:
1. Project Name: Bridge 990099, SR 1355 Bailev Branch Road
2. Name of Property OwnedApplicant: NC DOT
3. Name of ConsultandAgent:
"Agent authorization needs to be attached.
4. Related/Previous Action ID number(s):
5. Site Address: N/A
6. Subdivision Name:
7. City: Burnsville
8. County: Yancey
9. Lat: 35.96395 Long: _ 8233154 (Decimal Degrees Please )
10. Quadrangle Name: Burnsville
11. Waterway: Baile Branch
12. Watershed: French Broad River
13. Requested Action:
X Nationwide Permit # 14
General Pernut #
_ Jurisdictional Determination Request
_ Pre-Application Request
The following information will be completed by Corps office:
AID:
Prepare File Folder Assign number in ORM Begin Date
Authorization: Section 10 Section 404
Project Description/ Nature of Activity/ Project Purpose:
Site/Waters Name:
Keywords: