20171184 Ver 1_Shoreline Stabilization_20170918

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Telephone Number: �d� Z904_Ax Number:
E-mail Address: lS P� Q -+Cr -1 0, Car►n
Person to receive the Certification Approval: QRS e='&y ; 1 GAG P S
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• Project Information [15A NCAC 02H .0502(a) & (b)]
�' • 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.
r• 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: '// n?4 Nearest Town: rtA�w FJ /A
Subdivision name or site address (include phase/lot number):
Directions to site - please include road names and numbers, landmarks, etc.:
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Latitude (in decimal degrees) S• i k 671 Longitude (decimal degrees) — S • G U�
Describe the existing land use or condition of the site at the time of this
application (residential, undeveloped, etc.): %7ac►' onf)G 1 01)dPUP(ljpec�
Property size (acres): !, 2-3
Lake/ river/ ocean adjacent to property: W 14 Ll

Describe proposed work (include discussion as to how hardening of shoreline
has been avoided, or why it is necessary): ey; S4-/ nQ Lan 1 S -Cr ,ot i n9
� w u a _ r' ,� i d -e-
Will work be conducted fro land? Fro � L -
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: t00 s' -p
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: /60 S�
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):
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Owner/Agent's Signature* Printed Name
Date
[15A NCAC 02H .0502(f)l
"Agent's signature is valid only if an authorization letter from the owner is provided.
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Full Pond/
Normal Water Level
� � .v.
Shoreline
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/ Normal 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
• Location of construction access corridors
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Lake
(At Full Pond/ Normal Water
Level)
Full Pond/
Normal Water Level
� � .v.
Shoreline
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/ Normal 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
• Location of construction access corridors
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SAMPLE AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO. PLAN NO. PARCEL ID:
STREEADDRESS: —`>
1 M rJ 1
Please print:
Property Owner:
Property Owner:
bre \/t-1
The undersigned, registered property owners of the above noted property, do hereby authorize
of l/lJahAJ 0c / �0AtAp. ow)mtCtzn�-
(Contractor / gent) (Name of consulting firm)
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: i ©c ? 't �p q9
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
()'O +
4AoLriz2ed Signature Authorized Signature
Date: Date:

Email*
To enter the Latitude and Longitude of the property, please use a
service/software to easily acquire the location information. Values Latitude (e.g. 35.12345)*
should be provided in Decimal Degrees format (35.1245)
Longitude (e.g. -80.12345)"'
example service; ;http://itouchmap.com/latlong html -- -
y- PROPOSED';ACTI�/ITl'
C New/Modification of Existing Structure C Maintenance of Existing Structure j—
Is Dock
Covered?
C, New/Modification of Existing Shoreline Stabilization
C New/Modification of Existing Structure & Stabilization
C Transfer of Ownership
(- Maintenance of Existing Shoreline Stabilization
('Maintenance of Existing Structure & Stabilization # of Slips
C Other (please describe below) # of Jetports
Area over land (sq ft) Area over water (sq ft) Total Square Feet
Shoreline Stabilization (feet) Length of Distance From Shoreline
Stabilization
Materials
Brief Description
of the Activity
Describe Briefly the Existing
Structures Over Land and
Water (include sq ft)

Recent Survey (stamped/signed by a professional licensed surveyor showing the location of the existing or proposed
r' structure and/or survey of the existing or proposed stabilization)
I—, Photos along property shoreline and photos of any existing structures and/or stabilization in or near the water
F- Application fee (check only, payable to Duke Energy) j- Signed User Agreement Letter
n Applicable local, state, and federal permits [I Plan and profile drawing showing all measurements and elevations
17J Habitat Enhancement payment (if applicable)
• Application is reviewed and determined if complete. Fields with an asteriskarerequired.
• If application is not complete or does not include all items and information listed in the checklist, the
application will be returned as incomplete.
• A Duke Energy representative will visit the site to conduct a visual inspection.
• Applicant will be notified of approval or denial.
• Applicant is to have the notice, to be supplied by Duke Energy upon application approval, posted and
must be viewable from water. The notice must remain posted until a representative inspects the
project and determines the project is complete and within the application specifications.
nVl#1 xDireitionsby Road
Directions by
Road*
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Please complete, print and sign this application. Then enclose all items from the checklist above in an envelope and
submit all the information to the address below.
Water strategy, Hydro Licensing and Lake Services ` Print,Form.l,
Duke Energy
PQ Box 11006/ EC112Q
Charlotte, NC 28201
1 agree that the information contained within is accurate: