20181304 Ver 1_Shoreline Stabilization_20180925

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Water Resources
ENVIRONMENTAL QUALITY
State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
15A NCAC 02H.0500 —
Shoreline Stabilization
FORM: SSGP 02-2017
Shoreline Stabilization Application Form 2 0 1 8 1 3 0 4
Three copies of the application (including attachments) and the application fee should be sent to:
If sending via US Postal Service If sending via delivery service (UPS. FedEx, etc.)
Karen Higgins Karen Higgins
DWR-401 & Buffer Permitting Branch DWR-401 & Buffer Permitting Branch
1617 Mait Service Center 512 N. Salisbury Street
Raleigh, NC 27699-1617 Raleigh, NC 27604 rtft
A. Applicant Information f 15 NCAC 02H .0502(a)]
1. Owner Informatio
Name:
Mailing Address:
SFP 2 2018
ti
Telephone Number: rl Fax Number:
E-mail Address: t PQ.k7� OL %kc e i. ,r o 0 0
2. Agent/ Contact Person information
A signed and dated copy of the Agent Authorization letter must be attached if the Agent has
signed this application form. (A form can be downloaded here:
http://www saw usace army mil/Portals/59/docs/regulatory/regdocs/Permits/SAMPLE AGENT AUTHORI
ZATION FORM,
pdf) f (�
Name:7
o� V�c3,.s
Company Affiliation: �.
Mailing Address: 1 `1 ,, CC
0 1V -Q, • -u4'0t
Telepffane Number: 49 5 - Fax Number:
E-mail Address:
B. Project Information f 15 NCAC 02H .0502(a) & (b)]
1. 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.
2. Provide a detailed site pfan showing property boundaries and proposed locations of
vegetation clearing, buildings, retaining walls, docks, impervious surfaces, 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.
FORM: SSGP 02-2017 Page 1 of 3

l
3. Attach a photograph of the shoreline/ buffer proposed to be stabilized. (Include a
scale of some sort a yard stick, shovel handle, etc.)
4. Location 1of the property (where work is to be conducted)
County: Nearest Town:
Lake/ river/ ocean adjacent to property: C.
Property size (acres): O b
Subdivision name or site address (include phase/lot number): io O XRI`c\ C,R"AS
s .
DireQns to s to- pleas includ oad�a es,�nn�um sr�, ranarrew.
,ala/�c a '11..1Cbs �1�al�M• Ow ' w �s N Mw
�r�1.T Ts ate. Mhk. +d. �w�i► �Wtw d 2.31 %:. «.an aS� CW
. �� wi. 'P►vri wr.es Gr - tN � o Zq �� e w �.
Latitude (in decimal degrees) 35. `� $ 5 Longitude (decimal degrees) - • 3 to
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): 'Re_&
6. Describe proposed work (includeeiscu on as to how hardening shoreline has
been av ided, or why it is necessary): _ a� �-� �rS P ' "` f'
-P. t— eross6vl.
7. Will work be conducted from land? 0
From water? R+'*�_
8. Total amount of impacts bellow the normal pool lake level / Normal Water Level
Permanent impacts (including all excavation, backfill, rip rap, retaining walls, etc.) in square
feet: I ' G C Loo 4 /JrJV fncI pod ( / ro 'SF
Temporary impacts in square feet: - LY ec7 s
�/v �cr►.�vVCv'�
9. Total amount of impacts above the normal pool lake level / Normal Water Level and
50 feet land -ward
Permanent impacts (including back fill, excavation, rip rap, retaining watts, etc.) in square
feet: App,,t At ro Sr -
Temporary impacts (temporary clearing, construction corridor) in square feet:
10. Please describe the vegetation above the normal pool lake level% Normal Water Level
andAO feet landward to be impacted (number of trees, for instance):
o✓&S CVOS4Or%J Zve-i C�uuo
L r eft
11. Signature
FORM: SSCP 02-2017
�!u ! -r
fmQPoc� �� V ee S r Sr©,s S or �t,e•�
er.
Page 2 of 3

Se�rL.
Owner/Agent's Signatu (15A NCAC 02H .0502(f)] 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 levet
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
Full Pond/ Normal Water Levu
Shoreline w
Lake 0
(At Full Pond/ Normal Water Level)
C
is
EL
L 0
Z i
Side View-
Ftdl Pond/ Normal Water Le
M*15ok
a d -ft
• tF�assay
FORM: SSGP 02-2017 Plan View
Lake
10i10'
Lake
r c�� •=�—t
AMP.UE
3ftx150ft
/S-O'ST
_t
,4Y 5-z> SF
Page 3 of 3
KIM

CATAWBA RIPARIAN BUFFER NOTIFICATION FORM
Project Name/address: ba on 0" &RA Q� "%>w • County:
Owner:
Print
Contractor/agent:
Print
Signature
The approval is for the purpose and design described in your application. Impacts not indicated in the
application is a violation of the Buffer Rule. Site specific work should be provided in the application. [15A NCAC
02H .0506 and 15A NCAC 02B.0243(8)]
Trees are not allowed to be removed from Zone 1 of the Buffer (within 30 ft of the full pond elevation), unless
approved. Exception, those trees that are severely undermined along the immediate shoreline can be
removed. Minimal shaping and sloping along the immediate shoreline is allowed. [15A NCAC 02B.0243(6)]
Benching, grading in the buffer is not allowed. Excessive disturbance of ground cover. [15A NCAC 02B .0243
(6)]
Beaches, impervious patios, impervious walkways, etc. are not allowed in the buffer unless specifically
approved by the Division. There are limitation on size for decks. [15A NCAC 02B.0243(4) and (6)]
Work to be conducted from land must indicate an access and indicate any trees that are to be removed. The
work corridor should be described. The approved access corridor shall be restored. Staging, spoil, construction
material must be outside the buffer. [15A NCAC 02H .0502 and 15A NCAC 02B.0243 (4), (6), (8)]
Stormwater cannot be piped or channeled for direct discharge to the lake. All constructed stormwater
discharges must be at the natural elevation and discharged prior to entering the buffer directed as diffuse or
sheet flow at non-erosive velocities to the lake. [15A NCAC 02B .0243(5), (6)]
Acknowledgement of Notification
hereby state that I have been informed of the Catawba
Riparian Buffer R Any work c ucted in the buffer, not specifically stated in the application and approved
by the Division of Water Resources (DWR), is a violation and subject to enforcement. Due diligence will be
taken such that the construction will be built within substantial compliance and intent of the 401 Water
Quality Certification and Buffer Rules, the approved plan(s) and specification(s), and other supporting
materials.
Signature (owner): 0"� Date:

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This map is NOT of land survey quality and is NOT suitable for such use.
Owner
BENFIELD DORIS BARLOW
Deferred Val
$
Caldwell County
Assessed Val
$245,600
d
6029 GOLD CREEK
1:2,281
HICKORY, NC 28601
Calc Acreage
0.66115344
0 0.0175 0.035 0.07 mi
Land Units
1 (LT)
ti�TI,, ' , ' , I —I
Acct Number
41218
Legal Desc
6029 3T 9? rar
0 0.03 0.06 0.12 km
Parcel ID
08130A 1 29
NCPIN
2794882900
ih (1.1IA)M
/
September 13, 2018
Property Addr
6029 GOLD CREEK ESTATES DR
r
3961 R 60`13
34
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This map is NOT of land survey quality and is NOT suitable for such use.
Owner
BENFIELD DORIS BARLOW
Deferred Val
$
Caldwell County
Assessed Val
$245,600
6029 GOLD CREEK
1:2,281
HICKORY, NC 28601
Calc Acreage
0.66115344
0 0.0175 0.035 0.07 mi
Land Units
1 (LT)
ti�TI,, ' , ' , I —I
Acct Number
41218
Legal Desc
0869/0565 0085 20.00
0 0.03 0.06 0.12 km
Parcel ID
08130A 1 29
NCPIN
2794882900
Plat Ref
/
September 13, 2018
Property Addr
6029 GOLD CREEK ESTATES DR

1 49.8
152. 4
128 29 30
(1.11A)
do
2900 3961
0886 6029
171.7
tp
1:10 -= GOLD CREEK ESTATE DR -- SR 1857
This map is NOT of land survey quality and is NOT suitable for such use.
Owner
BENFIELD DORIS BARLOW
Deferred Val
$
6029 GOLD CREEK
Assessed Val
$245,600
HICKORY, NC 28601
Calc Acreage
0.66115344
Land Units
1 (LT)
Acct Number
41218
Parcel ID
08130A 1 29
Legal Desc
0869/0565 0085 20.00
NCPIN
2794882900
Plat Ref
/
Property Addr
6029 GOLD CREEK ESTATES DR
Caldwell County
1:570
0 0.00475 0.0095 0.019 mi
0 0.0075 0.015 0.03 km
September 13, 2018

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This map is NOT of land survey quality and is NOT suitable for such use.
Owner BENFIELD DORIS BARLOW Deferred Val $ Caldwell County
6029 GOLD CREEK Assessed Val $245,600
Calc Acreage HICKORY, NC 28601 0.66115344 1:9,1230 0.075 0,15 0.3 mi
Land Units 1 (LT) iy J,—L1... ,�
Acct Number 41218
Parcel ID 08130A 1 29 Legal Desc 0869/0565 0085 20.00 0 0.125 0.25 0.5 km
NCPIN 2794882900 Plat Ref / September 13, 2018
Property Addr 6029 GOLD CREEK ESTATES DR

s
DUKE ENERGY INTERNAL USE ONLY Construction (ft., [XJKE
Date Received L APP Fee Amt Application ENERGY.
versimiga
Check # Check Date
Duke Energy Lake Services
Mail Code EC12Q
Site ID HEP Fee 526 S. Church St.
Charlotte, NC 28202
i. APPLIGAIVTORMATlOIAi (appticant mailing address and contact Information)
Name* � _ •,s t \ Primary Phone*
Address* n 'S� Secondary Phone
City* i �o State* t,� Zip Code (pD 1
Email
11. PROPERTY INFORMATION location of unit
Is there an existing dock or other facilities Yes (if yes, include Dock Tag #)* /.[oS . c, y,�o$ c Aro
along the shoreline property or over the Lake? El No
Address* Fboswi
ink County*
City* State*,1`v 9 Zip Code* b O� Lake*`
Subdivision G� Gvee Lot(s) 49
To enter the Latitude and Longitude of the property, please use
a service/software to acquire the location information. Values Latitude (e.g. 35.12345)* ?JJr•1 g�
should be provided in Decimal Degrees format (35.1245).
Example service: http-.//itouchmap.com/latlong.html Longitude (e.g. -80.12345)* v\ . 31,
11
111. PROPOSED ACTIVITY (check all that apply)
❑New/Modification of Existing Structure ❑Maintenance of Existing Structure
F -JN of Existing Shoreline Stabilizationaintenance of Existing Shoreline Stabilization
nTransfer of Ownership n Other (please describe below)
Structure size (square Is dock covered? ❑ Yes
feet)
No
Shoreline StabNiration (feet) Length of
Stabilization �rb
Brief Description of
the Activity
Materials
Number of slips
Number of jetports
Distance from Shoreline
FlU4f1- S %n 1?,,p pop -tt-� s4 al'? -t s are C,n
Describe Briefly the Existing
Structures Over Land and
Water (include sq ft)
�ivc�r�� pvcl, 1 c✓el�w �, /60 Sr
t
Sfe`S SG S'r'- -
Jcdsr-
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IV. Checklist oiquired Docrntc ltriilh
Survey (stamped/signed by a professional licensed 0' Applicable local, state, and federal permits
surveyor showing the location of the existing or Signed Applicant's User Agreement Letter
proposed structure and/or survey of the existing or 01
proposed stabilization) Plan and profile drawing showing all measurements
OrPhotos along property shoreline and photos of any
existing structures and/or stabilization in or near the
water
IffApplication fee (check only, payable to Duke Energy)
and elevations
Habitat Enhancement Program payment (if
applicable)
Please limit documents sizes to 11"X 17" or smaller.
V.
• Application is reviewed and determined if complete. Fields -with an asterisk are required.
• 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 approvat specifications.
VI_ t3lt ions by
Directions by Road*
C" s0" Shad. l;Pti. X41 • ,w.
Tu s .w: Qo
®- wbl
1 &t.
Iwo" rw
icalE
I�.'aS rw►. .� a�.�Co Y111,�1 Irl- �i.aw . �$ �•..
nc�,,,,,, --ice i �
-lrw0.++ ®ate. a�. w�► , L s
74 c A'Pn*w• 2.�'t w.. -'t vas r• d tr+�o C.Rui - 98A Il< . Ae� . %1 wU. ,
V-0 dent& ccc'Ua / a4 -i e�w . 310 w�:� . 6 0 gal Cb a'.
Please complete, print and sign this application. Then enclose all items from the checklist above and submit all the
information to the address below.
Duke Energy Lake Services
Mail Code EC12Q
526 S. Church St.
Charlotte, NC 28202
I agree the information contained within is accurate:
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YOUR TRIP TO:
6029 Gold Creek Estate Dr
14MIN 1 7.21111111111 R
Est. fuel cost. $0.76
Trip time based on traffic conditions as of 11:98 AM on
September 21, 2018. Current Traffic: Light
Print a full health report of your car with
HUM vehicle diagnostics (800) 906-z5o2
It
1. Start out going southwest on Shiloh Church Rd toward Rosenbahn Ln.
�/ Then 0.05 miles 0.05 total miles
-t 2. Stay straight to go onto Hubbard Rd
Then 0.62 miles 0.67 total miles
3. Tum right to stay on Hubbard Rd.
Hubbard Rd is%ust past Cook Ln.
If you are on Cemetery Loop and reach Doberman Ln you've gone a little too far-
Then
arThen 1.38 miles 2.04 total miles
,r 4. Hubbard Rd becomes Icard Dam Rd.
Then 1.38 miles - 3.42 total miles
`1 ft
5. Turn leonto Petra Mill Rd.
Then 0.88 miles 4.30 total miles
6. Tum right onto Rocky Mount Rd.
Then 0.02 miles 4.32 total miles
+1 7. Tum left onto Grace Chapel Rd.
Then 2.37 miles 6.69 total miles
8. Tum right onto Creek Estates Dr.
Creek Estates Dr is 0.1 miles past Mountainside Dr.
If you reach Mountainside Dr you've gone about 0.2 miles too far-
Then
arThen 0.16 miles 6.84 total miles
,r 9. Creek Estates Dr becomes Gold Creek Estate Dr_
Then 0.36 miles 7.20 total miles
�t 10. 6029 Gold Creek Estate Dr, Hickory, NC 28601-9432,6029 GOLD CREEK
ESTATE DR is on the left.
Your destination is 0.2 miles past Gold Creek Estate Dr.
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DUKE ENERGY PRIVATE FACILITIES
"APPLICANT'S USER AGREEMENT"
(Fill in blanks with required information. Please Print)
Date 9 ki. I La.
TO: Duke Energy
c/o Lake Services - EC 12Q
526 S. Church Street
Charlotte, NC 28202
RE: (Lake Name) v\I 0
(Lake Address) La ()a q Q1
(Applicant's full name) `� kyZA� 1 Sp.V� hereby
agrees to comply with all requirements and corWRions set forl)by Duke Energy's Lake Services
(Duke Energy) office, and any federal, state or local agencies pertaining to our application to
construct and/or maintain a
5ti10 ��h� on Lake \&OgAk. In addition,
Uwe have read and agree to comply with Duke Energy's Shoreline Managemsib Guidelines
(SMG) and understand that written authorization must be obtained from Duke Energy prior to
beginning any activity/construction within the Federal Energy Regulatory Commission (FERC)
Project boundary. The construction will be completed as described in the approved application
and within twelve (12) months following the date of approval by Duke Energy. An extension
will be considered for legitimate extenuating circumstances (as determined by the sole discretion
of Duke Energy) provided a specific timeframe in which to complete the construction, not to
exceed an additional 12 months, is provided in writing to Duke Energy by the applicant. Failure
to complete construction within the 12 -month build -out period or any Duke Energy approved
extension will require the applicant to file a new application that complies with the then -current
SMG. The new application filing will include any applicable fees and security deposits.
Uwe attest to be the owner or lease holder of the tract of land immediately adjoining the Project
boundary where the proposed private facility is to be constructed.
Uwe agree to comply with all FERC orders (as modified or interpreted by FERC), with all other
applicable FERC Rules and Regulations implemented by Duke Energy, and with all rules or
regulations imposed on Duke Energy by any governmental agency.
Page 1 of 5
Rev 11/92016

Uwe understand the physical location of my/our lot in relation to the common property line with
Duke Energy, if any, the FERC Project boundary, and any deeded flood easements or required
building setbacks.
Ifwe understand that this lake was constructed as a working hydropower reservoir for the primary
purpose of producing cost-effective electric energy and that this remains as the lake's primary
purpose. Ifwe understand the lake and its associated hydroelectric facilities are operated by Duke
Energy under the terms of a license issued by the FERC and there will be no change in hydro
project operations as a result of the construction and/or use of any facilities that Uwe may be
allowed to place within the FERC Project boundary or on any Duke Energy -owned property.
Uwe understand during drought conditions Duke Energy may request reduced usage or
discontinued usage of any water withdrawal or related systems, until such drought conditions
improve. Failure to do so may cause possible removal of the system and/or any other permitted
facilities that Uwe may have, and any costs associated with removal of the facilities will be
assessed to the lot owner.
Uwe understand lake levels will rise and fall over time in response to weather events and hydro
project operations and Duke Energy does not guarantee an approved facility will always have
sufficient water depth to be accessible by boat or for other water depth related recreation
activities.
.Uwe acknowledge Duke Energy provides no guarantee of any specific quantities (except those
identified in the FERC license) or quality of water in the lake.
Uwe understand the facilities to be installed and/or maintained are my/our property and I/we
therefore agree to be fully responsible for the permitted reservoir use including maintaining
facilities in good repair. If the private facility is deemed unsafe by Duke Energy, Uwe agree to
repair or remove the private facility at my/our own expense and within the specified timeframe
set by Duke Energy.
Uwe understand Duke Energy approval of the requested reservoir use in no way constitutes
assignment of any interest in real property Duke Energy may have (i.e. land rights). The approval
is granted and maintained solely at Duke Energy's discretion. Uwe also understand the permitted
use may be revoked at any time by Duke Energy or its successors for any reason whatsoever. If
the approval is revoked, Uwe agree to remove the facility at my/our own expense within the
specified timeframe set by Duke Energy.
Uwe understand ownership/interest in a Common Use Facility or residential marina eliminates
the option of having a separate private facility on any other owned or ]eased lot within the
affected subdivision.
Uwe understand this lake is open for use by the general public and that maintaining safe and
lawful public use is one of the primary lake management objectives of Duke Energy.
Page 2 of 5
Rev 1 f 9/1016

Uwe understand the use for which we are applying is a private use and it should not interfere with
the general public's safe and lawful use of the lake.
Uwe understand lake use permit holders have the authority to prevent others from trespassing on
the facilities Uwe have built. Ave also understand Ave, however, do not have any authority to
impede anyone from pursuit of the lawful public recreation enjoyment of FERC Project lands
and waters. Except as specified otherwise in the SMG, other Duke Energy documents (e.g.
Public Safety Plans), or a separate lease agreement, anyone may fish around/under facilities built
by others, may walk/wade/fish within the FERC Project boundary, boat in the lake's waters, etc.
without having to get anyone's permission to do so.
-1/we agree to fully disclose all information regarding the approved private facility to any
prospective buyer/leaseholder of the property and any new owner/leaseholder. Fwe agree to
notify Duke Energy immediately of any sale/transfer of the property, including the name and
address of the new owner and to transfer the permit and/or Duke Energy lease to the new owner.
Uwe agree the adjacent Duke Energy Project property, if any, shall be used exclusively for non-
commercial recreational purposes and that Uwe shall not rent or otherwise allow third parties
(except for temporary use by guests, family members, and leaseholders of the residential
property) to use any facilities permitted to me/us by Duke Energy.
Uwe agree not to allow any use of the adjacent property, and will exercise due care and diligence
to prevent all other persons that are affiliated with my/our property (including invitees, family
members, guests, etc.), to violate an applicable federal, state or local law or regulation. Examples
include, but are not limited to nudity, illegal discharge of firearms or fireworks, controlled
substance abuse, public drunkenness, public urination or defecation, or other activities
determined to be a nuisance by law enforcement officials.
Uwe agree to exercise all care and due diligence to preserve and maintain the character of the
Duke Energy's adjacent property, if any. Uwe agree to comply with the Duke Energy vegetation
management requirements as stated in the SMG. Uwe agree further to not allow sewage,
including discharge from septic tanks (or similar facilities) or boat holding tanks, garbage, trash,
or other waste material to be discharged or dumped into the reservoir, tributaries or adjacent
property.
Ilwe understand that as an adjoining property owner Uwe can make no change in land form of
land within the FERC Project boundary or land owned by Duke Energy, if any, such as grading,
excavation or filling without prior written approval by Duke Energy.
Uwe agree for myself/ourselves, members of my/our family, guests and invitees that Fwe assume
all risks of personal injury or property damage incident to mylour occupancy and use of the
FERC Project boundary or land owned by Duke Energy, if any; including, but not limited to, any
personal injury or property damage which may be sustained as a result of flood waters or in
connection with the rise and fall of water in the reservoir as a result of floods or of the operation
of Duke Energy's hydroelectric facilities. I/we as the adjoining property owner(s) further agree
Uwe will indemnify, protect, defend, and save harmless Duke Energy from any and all loss, cost,
Page 3 of 5
Rev 11/92016

claims damages, expenses, judgments and causes of action for all injuries and damages sustained
by the members of my/our family, guests, and invitees arising or claimed to have arisen in
connection with their occupancy or use of the Duke Energy permitted facility(s).
Uwe agree if any action is taken by Duke Energy to enforce any provision, covenant or
agreement contained in this user agreement or Duke Energy SMG or if Duke Energy is required
to retain an attorney to enforce any provision, covenant or agreement contained in this user
agreement or SMG (including, without limitation, the payment of fees due hereunder or the
removal of an encroachment constructed in violation of this user agreement or SMG), then Duke
Energy shall be entitled to recover all of its reasonable costs associated with such an action,
including but not limited to, attorneys' fees and court costs incurred in such action and/or
enforcement.
Uwe understand certain activities specified in the SMG are prohibited because of environmental
concerns, boating capacity limitations, safety considerations and other reasons.
1/we specifically waive any claim against Duke Energy for consequential damages arising out of
or relating to this application, Duke Energy's approval or denial of it, or subsequent revocation
of approval, and Uwe specifically understand and acknowledge that, because Duke Energy can
revoke the permitted use at any time, Uwe am/are not entitled to reliance damages.
Uwe understand the proposed facility will be used only for the purposes described in the
information submitted to Duke Energy and other appropriate governing bodies for approval.
Uwe understand every reasonable effort must be made to minimize adverse impacts on fish,
wildlife, and other natural resources.
Uwe understand trees and vegetation growing within the Project boundary play an important role
in the overall environmental condition of the lake. The ecological benefit the vegetation has on
the fish and wildlife habitat supports a sound and healthy lake environment. Uwe also understand
unauthorized removal of shoreline vegetation and/or disturbance of the shoreline buffer may
result in suspension or denial of lake use permitting requests and require me/us to re-establish the
vegetation, if the disturbance is found to be in violation of the state or county watershed buffer
regulations or Duke Energy's vegetation management requirements as stated in the SMG.
Uwe agree to maintain any prescribed mitigation activities that are required in order to gain
approval for facility construction, as long as the facility exists.
Uwe recognize Uwe have the continuing responsibility to ensure that the constructed facilities are
maintained in good repair, including, but not limited to maintenance of the facilities, and proper
erosion control within the permit area and along the shoreline, and agree to take all reasonable
steps necessary to meet this responsibility. Ave agree to maintain all facilities within the Project
boundary and on Duke Energy -owned property, if any, in a sound condition and in a neat
appearance and pay all costs for said maintenance.
Page 4 of 5
Rev 11P92016

b'we understand Duke Energy representatives may issue Stop Work Directives for any
violation(s) of the SMG or engagement in prohibited acts or activities on Duke Energy property,
if any, as specifically identified in the SMG. Ave understand persons found to be in violation
will be subject to Duke Energy sanctions which can include, but are not necessarily limited to: 1)
restoration of the impacted area at the person's expense; 2) loss of consideration of any firture
lake use permitting activities for up to five years for improper vegetation removal or until
vegetation is satisfactorily re-established (even if there is a change in property ownership); 3)
revocation of a previously issued permit and loss of consideration of any future lake use
permitting activities and/or reinstatement of the revoked permit; 4) increase in fees; 5)
modification or removal of non -complying facilities; and/or 6) further legal action being taken
by Duke Energy.
1/we agree that if any historic or archaeological resources are discovered during construction of
an approved activity the applicant must stop work immediately and contact Duke Energy. Uwe
understand that in the event that anyone discovers a potential site of archaeological or historic
significance including any gravesite within the Project, the individual must immediately notify
Duke Energy.
Uwe acknowledge Duke Energy has the right to charge reasonable user's fees for private use of
its property, if any, and the Project and failure to pay any applicable user's fees in a timely
manner can result in the suspension or cancellation of any previously approved lake use permit.
Uwe agree to notify Duke Energy when construction is completed and during the construction
period, Uwe will post the Duke Energy approval (to be provided by Duke Energy) at the job site
visible from the water's edge.
Applicant Name
rQ
Lake Street Address
City/State/Zip Code
Preferred contact Phone Number
E) 01 --IL
Applicant Signature
it
Home Mailing Address
1, S MIVA,1.
City/State/Zip Code
ID
A 3 as
Home Phone Number
Ir
e S&S
0,0 CA ly1
Zn?hl Address
Date
Page 5 of 5
Rev 11/9/2016