20090260 Ver 1_401 Application_20090312

03/10/2009 19:27 2524787778 CREEKSIDE INC PAGE 02/11
C9-0260
The following is an abbreviated application form for those applying for a 401 Water Quah
Certification to impact + +RC (Federal Energy Regulatory Commission) regulated lake shore IV A, bottom under the U.S. Army Corps of Engineers Permit GP30. This Application cannot be used 'fops q,
F ?O ??•
for wetland or stream impacts. Please provide five (5) copies of this application and supporting 21 Z1Pp? 09
information as well as a non-refundable application fee to thy; Division of Water Quality of $240.00 'q fury
for impacts to lake bottom of less than 1 acre and $570.00 for impacts to lake bottom of greater or
equal to I acre. ti
Applications should be sent to:
Division of Water Quality 401 Oversight/Express Review Permitting
1650 Mail Service Center t
4
Raleigh, NC 27699-1650 1.
L Applicant Information
Owner/Applicant Information
Name: I '., Joe r_?
Mailing Address 94
2.
Telephone Number: C9! 9} do Tev ?J?S?D Fax Number: (119) Z71-45-11
E-mail Address: ?B N Ac I C t `7 N r4 Q et . ac-0
Agent Information (A signed and dated copy of the Agev Authorization letter must be attached
if the Agent has signatory authority for the owner/applicait.)
Name: --
Company Affiliation:
Mailing Address:
Telephone Number:
E-mail Address;
U. Project Information
Fax Number:
Attach a vicinity map clearly showing the location of the proper y with respect to local landmarks such
as towns, rivers, and roads. Also provide a detailed site plan showing property boundaries and
development plans in relation to surrounding properties. You may use the diagram below to make a
hand sketch of your project. Also, see the example below for guidance. Both the vicinity map and site
plan must include a scale and north arrow. The footprints of all b rildings, impervious surfaces, or other
facilities must be included.
Ta?c 27(Q1S-
03/10/2009 19:27 2524787778 CREEKSIDlE INC PACE 03/11
1. Location
County:) Nearest Town: 13 u n l?
Subdivision name or site address (include phaseflot number): ?l ke C
Directions to site please include road numbers, landmarks, etc. ("his is not necessary
vicinity map is included)- 1101.4. t ot,.a_ O i?
k17
adequate
Mo t°_.
2, Describe the existing land use or condition of the site at the time of this application'
3. Property sire (acres): , ?-d a 10
4. Nearest body of water (stream/river/sound/ocean lake): 1 I V e,lr' yy ""
5. Describe the purpose of the proposed work: Q ?.
how 9,u x aW , , ?s ?lvl Q I -Loa 11
6. List the type of equipment to be used to construct. the prq ect: P 'XL Lt VOI:?
7. Amount of impact (including all excavation, baekfill, rip ap, retaining walls, etc.) below the
normal pool lake level in square feet or acres: I Q )? - -4 i n W
8,a. Amount of impact (including all clearing, back fill, excavation, rip rap, retaining walls, etc.)
above?the normal pool 1 ke level and 50 fact I . -ward in square feet or acres: f (_
1,,..- . i n, Aeh r i A -i1,. 0 1 fi'voCi I Ll''. aQ 1 t?,t ame;Y1A T]tJC
8.b. Please describe vegetation above the normal pool lake level and 50 feet landward to be impacted
(number of trees for instance): ?1 aiA Q dm 10
rn0A J
M20-e ? ( z , ZOD
Applicant/Agent's Si tune Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
03/10/2009 19:27 2524787778 CREEKSIDE INC PAGE 04/11

Lake (Full Porrd)
&S?it5 &ck Vv
Fall Pond 5t? ? 1!
5?+?retine ?x??ti
%
SO?+ ZE>ne 2
Lq C4- e;3
a of ri
Please approximately sketch the following Informa Ion on this plan
jp'%me, provxfe des for each item, SuCh as 10 ft. x 100 ft):
1) All proposed vegetation clearing (pravide (11merrsions)
.2) Locatlort of rip reap or fill to be placed above tha FW1 Pond elemtion
3) Locatirm of rip rap or fM to be placed below tare Ptrii Pond elevat On
4) The location of any proposer! structures such as buildings, retaining
galls, docks, ate,
v) The location of any xemation or dredging below the Full Pont
elevation.
6) Location of construction acmes aorridom
03/10/2009 19:27 2524787778 CREEK5IDE INC r'acat M/11
EFM #1
Subject Photo Page
Bortowar bent ROBERT AND A USA HEYWARD
Property Address 1271 Saoamore Dr
Clt LOUISBURG Counly FRANKLIN State NC 712 Code 27587
Lender DB8T RT AGE
Subject lakefront view
1271 Sagamore Dr
sales Plea 429,000
Gross Living Area 2,022
Total Rooms 8
Total Bedrooms 3
Total Bathrooms 2,5
Locatlon Lake Royale
View waterfront
site 0,48 achakefmt
Quality average
Age 14 act 15 off
Form MUMS -' WInTOTAL" appralsal software by a la made, i la --1 •BOO•ALAMOOE
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CREEY.SII}E INC
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