20170513 Ver 1_Shoreline Stabilization_20170426

Montalvo, Sheri A
From: Susan Thompson <[e-mail]>
Sent: Tuesday, May 02, 2017 9:25 PM
To: Montalvo, Sheri A
Subject: Re: Shoreline stabilization application
Sheri,
Please shred that checkand we will send you a new one.
Sorry and thanks,
David and Susan
From: "Montalvo, Sheri A" <[e-mail]>
To: "[e-mail]" <[e-mail]>
Sent: Thursday, April 27, 2017 2:21 PM
Subject: Shoreline stabilization application
Susan,
We received your application for the above. The fee you sent in is too much. The fee is
$240. We can either send back to you the check and you can write one out and send it
in for the $240 or we can shred the check here in the office and you can send a new
one for $240. Please let me know which one is best for you. The project will be placed
on hold until we receive the $240 fee.
Thanks
Sheri Montalvo
Administrative Assistant
401 & Buffer Permitting Branch
Division of Water Resources
North Carolina Department of Environmental Quality
919-807-6303 (office)
919 807-6494 (fax)
sheri.montalvo(5-ncdenr.gov
Physical: 512 N. Salisbury St., Ste 942-D, Raleigh, NC 27604
Mailing: 1617 Mail Service Center, Raleigh, NC 27699-1617
1

Email correspondence to and from this address is subject to the
North Carolina Public Records Law and may be disclosed to third parties.

X01705�3
State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
Division of Water Resources 15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
FORM: SSGP 10-2013
Shoreline Stabilization Application Form
Three copies of the application (including attachments) and the application fee should be sent to:
Division of Water Resources D
401 & Buffer Permitting Unit D
1617 Mail Service Center 1f'k 2 n 2017
Raleigh, NC 27699-1617
I. Applicant Information
1. Owner Information _
Name: DoLU i
Mailing Address:
.L QX%Gtr �r /l% C• 2 7.� � 2
Telephone Number:33 C-50 ;Z 20/ Flax Number:
E-mail Address: lit �, yl /l d' 1 l3 > 6 A fw cimn_
2. Agent/ Contact Person Information
A signed and dated copy of the Agent Authorization letter (a form can be downloaded here:
) must be attached if the Agent has signed this application form.
Name:
Company Affiliation:
Mailing Address:
Telephone Number: Fax Number:
E-mail Address:
Person to receive the Certification Approval:
II. Project Information [ j
1. 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.
2. 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
FORM: SSGP 10-2013 Page 1 of 3

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: V'i'i- -0/^ Nearest Town: f JCli�tf %Y1Qy1
Subdivision name or site address (include phase/lot number):
Directionsto site - please .nclude road names and numbers landmarks, etc.:
r/11
C. e a OOr _ Gvo
e:
Latitude (in decimal degrees) Longitude (decimal degrees)
5. Describe the existing land use or conditi n of the site at the time of this application
(residential, undeveloped, etc.): Q�>r,C/( 17lie, P��� k7;ytP,
6. Property size (acres):
7. Lake/ river/ ocean adjacent to property: zW17Ck Z441f,
8. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary):
9. Will work be conducted from land? ® 0 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:
611 !U.
11. Total amount of disturbance (including all clearing, back fill, excavation, rip rap, retaining JrQ���
walls, etc.) above the normal pool lake.4evel/ Normal Water Level and 50 feet land -ward in �J
square feet or acres:
12. Please describe the vegetation above the normal pool lake level/ Normal Water Level and 50
feet landwardito be impacted (nurpber of trees, for instancy)
vvc fw`/ Am /
Owner/Agent's Signature' [ Date
=Agent's signature is valid only if an authorization fetter from the owner is provided.
FORM: SSGP 10-2013
Page 2 of 3

Davidson County Map Output Page
Y
avidson-�County GIS
EI
Parcel Number: 09009B0090001
Pin Id : $63941 -27-8577
Owner, /3�'61 r-
Property Address: 1131 SHORELINE DR
Township: 09
Building Value:
Land Value:
Land Units:
Deed Book:
Deed Date:
Account Number:
Exempt Code:
Other Building Value
Market Value:
Page 1 of 2
1 LT
2144 Pg: 0705
05/30/2014
9212118
http://webgis.co.davidson.nc.us/website/davidsongis/printpage.aspx 8/17/2015

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