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10. 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):
11. Signature
Owner/Agent's Signature f 15A NCAC 02H .0502(U Date
Agent's signature is valid only if an authorization letter
from the owner is provided.
12. Please approximately sketch the following information on this plan and provide dimensions for
each item:
a. All proposed vegetation clearing
b. Location of rip rap or fill to be placed above the Full Pond/ Normal Water Level elevation
C. Location of rip rap or fill to be placed below the Full Pond/ Normal Water Level elevation
d. Location of any proposed structures such as buildings, retaining walls, docks, etc.
e. Location of any excavation or dredging below the Full Pond/ Normal Water Level elevation
.0
Full Pond/ Normal Water Lev
77
� r
Shoreline
ef
C-.
Plan View
Lake
(At Full Pond/ Normal Water Level)
https://files.nc.gov/ncdeq/Water`/`20Quality/Surface`/*20Wate ... 0 Permit s/SSCP%2002-2017%20Shoreline%20Form_finaI.docx 8/6/18, 7:58 PM
Paye 3 of 4

Lake
Existing Dock
i h 1'x
FuF vond/ Normal Water level _
���ho ei ne TiLtr{ ii�li VYM �
R.prap
C
0
Side View
U-
i ft, below full pond "te-, leo+•I 4 ft. above full pond water level h. additional Bearing
'if necessary
Existing bank
loft u;:;I.
Side Vi
FORM: SSGP02-2017 Page I o1"3