20090278 Ver 1_401 Application_20090309

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The following is an abbreviated application form for those applying for a 401 Water Qu Rp /'
Certification to impact FERC (Federal Energy Regulatory Commission) regulated lake shor?
bottom under the U.S. Army Corps of Engineers Permit GP30. This Application cannot be used
for wetland or stream impacts. Please provide five (5) copies of this application and supporting
information as well as a non-refundable application fee to the Division of Water Quality of $240.00
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.
Applications should be sent to:
Division of Water Quality 401 Oversight/Express Review Permitting
f?s ID
P A IF
1650 Mail Service Center
Raleigh, NC 27699-1650 `"'?---
I• Applicant Information
1. Owner/Applicant Information
Name: L?o Lo z
Mailing Address:
nPnV e.r lQ C, 2?132 -7
Telephone Number: 6, 50 -!Y-334, Fax Number: 70 i? RL2-- 113
9
E-mail Address: el- Cf?irr.1
2. Agent Information (A signed and dated copy of the Agent Authorization letter must be attached
if the Agent has signatory authority for the owner/applicant.)
Name: eW tf GCI, 7
Company Affiliation:
Mailing Address:
Telephone Number: Fax Number:
E-mail Address:
II. Project Information
Attach a vicinity map clearly showing the location of the property with respect to local landmarks such
as towns, rivers, and roads. Also provide a detailed site plan showing property boundaries and
development plans iA 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 buildings, impervious surfaces, or other
facilities must be included.
1. Location
County: / . rJ - - f. Nearest Town: De A/ V 'Er4 A 1,C
Subdivision name or site address (include phase/lot number): 1?1?f_ S?p,,,k ID's 3 3
ye-
Directions to site please include road numbers, landmarks, etc. (This is not necessary if an adequate
vicinity map is included): 1W 1 e 1 nz t E.,4_
F -^
,tic(A s ii) CcdC COIAAA-c Fot N, ?n (e?_ roll., ..t ?..
__(' i. d ? !' ?. r .1 1• n n L.c?lc.t S n K N ' ?iN ? ] s-i.- b ^ L? ?+
3
2. Describe the existing land use or condition of the site at the time of this application:
3. Property size (acres): ' . (. acs L
4. Nearest body of water (stream/river/sound/ocean/lake): Lake ?vr?r-,?ct,•?
5. Describe the purpose of the proposed work: S ?o-l f Se < < o.*
r
6. List the type of equipment to be used to construct the project: 1M?kni. D L41.,r
7. Amount of impact (including all excavation, backfill, rip rap, retaining walls, etc.) below the
normal pool lake level in square feet or acres: n i ` (orrcr
8.a. Amount of impact (including all clearing, back fill, excavation, rip rap, retaining walls, etc.)
above the normal pool lake level and 50 feet land-ward in square feet or acres:
ua n v A k-- iv. -o rl 0.-,& t-, , t 1 bc_ 1 kc-1L C, CA
8.b. Please describe vegetation above the normal pool lake level and 50 feet landward to be impacted
(number of trees for instance): k *Er a yl-Ow R
Applicant/Agent's Signature v Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
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http://www. mapquest. com/maps?city=Denver& state=NC&address=4654+Lake+Shore+Rd... 3/13/2009
DUKE ENERGY LAKE SERVICES
EC12-Q 9 .__ 0 2 ' 8
P O BOX 1006 -
CHARLOTTE, NC 28201-1006
704-382-1567 or TOLL FREE 1-800-443-5193
APPLICATION FOR PERMIT TO STABILIZE THE SHORELINE IN NORTH CAROLINA
Please type or print and fill in all blanks. If information is not applicable, so indicate by placing N/A in blank. PLEASE
SUBMIT APPLICATION AND APPROPRIATE DUKE ENERGY FILING FEE, PAYABLE TO DUKE ENERGY,
TO ABOVE ADDRESS.
I• Applicant Information
A. Name V6 , , r 111. .?
B. Mailing Address ?V6s ??Ic S?..,, en P_0cl l1J
C. Telephone: 7]p14 - & S-e -crT?(2
II. Location of Proposed Project
A. Lake _ U pg4y%,gt4
B. Street Address _jec?q
C. CountyL,,,, ,-o [
D. City, town, community or landmarkUC,,-,j1e
E. Section Lot # ?230 _ Subdivision
F. Directions to propertyby road ??t7 U. 14e r4,1 A-
1" (4 a? I?.n 1
G. Latitude and longitude for the project situ ' ?s A $$' -5/1,
W
H. Please submit a map showing the coordinates or a detailed ma USGS quad map, city map, etc.) showing the
exact location of the project site. (NOTE: Latitude/ longitude coordinates can be found on internet site,
www.maysonus com. Directions: Don't register, click "Maps", enter address, draw map, select "Map Clicking
Will...", select "Lat/Long", click map)
III. Description of Project
A. Length of wall
B. Material r
C. Distance from p operty line/shoreline
IV. Intended Use of Project Area
V
PLEASE M. THE FOLLOWING:
• 2 COPIES OF THE "DUKE ENERGY APPLICATION FOR PERMIT TO STABILIZE THE SHORELINE IN NORTH
CAROLINA", PHOTOGRAPHS OF THE SHORELINE TO BE STABILIZED, AND FIVE (5) COPIES OF THE
COMPLETED "NC DIVISION OF WATER QUALITY PRE-CONSTRUCTION NOTIFICATION APPLICATION"
MUST BE SUBMITTED WITH THE DIVISION OF WATER QUALITY APPLICATION FEE TO:
NC DIVISION OF WATER QUALITY
ATTENTION. CYNDI KAROLY
PARKVIEW BLDG., 2321 CRABTREE BLVD.
RALEIGH, NC 27604
919-733-1786
A. Private irk
B. Commercial
Applicant Signature
Date _ - .?-nc-a---
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