20090391 Ver 1_Application_20090413

09-0391
The following is an abbreviated application form for those applying for a 401 Water Quality
Certification to impact FEKC (Federal Energy Regulatory Commission) regulated lake shore or
bottom under the U.S. Army Corps of Engineers Permit GP30. This Application cannot be used
for wetland or stream impacts. Please provide seven (7) 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 of to lake bottom of less than l acre and $570.00 for impacts to lake bottom of greater
or equal to I acre.
pplications should be sent to:
Division of Water Quality 401 Oversight/Express Review Permitting
16;4) k1gil LWrvive Venter
Raleinh, '=iC 2769946513 $ PA-1 j)
Y. Applicant laafforynation
c- JOL
11 zennt»e fVuYrilier:"-__l-d.
)JL
Ji Fax Number
E-mail Address: 'D-? fwt L 7? 1?,? ! 7 t2? ??1 Vr17? ?C Q I
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.) ??. `'_, r_.
Name:
Company Affiliation:
Mailing Address:
Telephone Number:
E-mail Address:
11. Project Information

"ETL:,;;D^??R, WATER CUAIITY
it-N
R?ar?
Fax Number:
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 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 buildings, impervious surfaces, or other
facilities must be included.
1. Location
County: U? Nearest Town:
Subdivision name or site address (include phasellot number): ` ?_f3 l }v2?. ??l)?r1 S?gll? UIsjZ;
Directions to site please include road numbers, landmarks, etc. (This is not necessary if an adequat
vicinity map is included):
11P_
uxv ?-M? 6, Gk-civc-l\ 'po?4f), __2) (II+ U di g ? C' ? , rA' , ? 1 ! JJOT
2. Describe the existing land use or condition of the site at the time of this application: r kk
3. Property size (acres): ?7S y i )<J )? ?=1 / ?7 fly ?.A)Jr ) t V
4. Nearest body of water (stream/river/sound/ocean/lake): NQh5}?c
5. Describe the of the ro osed work: y 1 r Y, L?
purpose ? p I?ai t ? l )lc
6. List the type of equipment to be used to construct the project: ,?iU,7Z j:Ll1'k%
7. Amount of impact (including all excavation, backfill, rip rap, retaining walls, etc.) below the
normal pool lake level in square feet or acres:
,?}T=
8.a. Amount of impact (including all clearing, back fill, excavation, rip rap, retaining walls, etc.)
above the normal pool lake level an50 feet land}--ward in square feet or cres:
r CAL-( t?? a Y7
8.b. Please describe vegetation above the//ne?on-,nal pool lake level and 50 feet landw/ard to be impacted
(number of trees for instance): (r' `; !/ c ? /
1

Applicant/Agent's Signature Date
i1-1 ge.
L s signature is valid only if an authorization letter from the applicant is provided.)
',
-.
_? ?.
11
a,
a
low
n
AL
AAa v �
M
r �

- AiW- ?141

71
M
0
it
;3 } a .,:
r
.40
w t t',#
Vis
1
? ?? ? •?', ? tit ? ^? , ? r ? ?
Y!?,
a
'1MR '?t4 c 1 ? its y- , ? %,?.°^r} F 4 T ?
w
,` s 1 a s? r r r, , ?.,.
+.! M t-
Mill,
`}"' i(1 '•? ?'
S f- t
'Ok •1 ?i
t
rr? ? .1 Ale
,
4 A."
it rof ?'`•A
S rI ? s
t y
r.
LIE,
r ;? " ,ei t 4 I 4' s
?4?wr{?'?. ? 14 !err ?•?µr ? ? ` ? ?4 ? s r¢ ? ??'?,?
rf ?y ?
4 '
a

t" A,,

JJX

i
a
,a
J

?
1- IZ ? N
?? o
n: t
d N
L
r
T" J d
c ?
s u
a

I??O?Jar?d _o
v
-U
4
?
J J
(?
ul ?_-
U'
r-
C
OD
O a ?
d
1 rq L
o L ??
o
a
?'oo,

0
W
i
_O
;0 J

4..
J
4

v! d