20090762 Ver 1_Application_20090709

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The following is an abbreviated application form for those applying for a 401 Water Quality
Certification to impact FERC (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 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 1 acre. $PAID
Applications should be sent to:
Division of Water Quality 401 Oversight/Express Review Permitting
1650 Mail Service Center
Raleigh, NC 27699-1650
I. Applicant Information
1. Owner/Applicant Information
Name:
Mailing Address: L4 ?C1 W w'
T0-1ulc rs V", ?J
Telephone Number: Fax Number:
E-mail Address: W c,-L1 •'iA--L 0 1?. n
2. Agent Information (A signed and dated copy of the Agent Authorization lettdyAust A ?Ned
if the Agent has signatory authority for the owner/applicant.) DENR - WATER WALITY
WETLANDS AND STORMWATER BRANCH
Name: f t•- -4., s
Company Affiliation:
Mailing Address: r2 a L c i
Telephone Number:' Fax Number:
E-mail Address: iNI t,rIel f- CC,'l
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 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: AeiGzr Nearest Town:
Subdivision name or site address (include phase/lot number): L p? ?© Wt1mk a" L !' b.6VJ'6.
Directions to site please include road numbers, landmarks, etc. (This is not necessary if an adequate
vicinity map is included): Iwr+r'1 ?'U?,41k ar\?6 Lr) . OW 0
?h I rc.r1 ["wit LOA or, [4_ 16.&A.- O[A WWkktt-
?? mot";"
2. Describe the existing land use or condition of the site at the time of this application:
3. Property size (acres): ZY A < < ---
4. Nearest body of water (stream/river/sound/ocea ake): - +'K e
5. Describe the purpose of the proposed work:
6. List the type of equipment to be used to construct the project: cl .-
7. Amount of impact (including all excavation, backfill, rip rap, retaining walls, etc.) below the
normal pool lake level in square feet or acres: C:?
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:
y? L ( l ?fv'f'M; i y--
8.b. Please describe vegetation above the normal pool lake level and 50 feet landward to be impacted
(number of trees for instance):

Applicant/Agent's ignature Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
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410 wildlife club In taylorsville n.c. 28681 - Google Maps
Page 1 of 1
http://maps.google.com/maps?q=410+wildlife+club+ln+taylorsville+n.c.+28681 &ie=UTF8... 7/7/2009
Address 410 Wildlife Club Ln Get Google Maps on your phone
Get e maps Taylorsville, NC 28681 Text the word"GMAPS"to 466453
Reports
Alexander County, NC
Tax Parcel Report
Page 1 of 1
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*WARNING: THIS IS NOT Tuesday, 7/7/2009
A SURVEY!*
This map is prepared for the
inventory of real property
found within this
jurisdiction, and is compiled
from recorded deeds, plats,
and other public records and
data. Users of this map are
hereby notified that the
aforementioned public
primary information sources
should be consulted for
verification of the
information contained on this
map. The County and
mapping company assume
no legal responsibility for the
information contained on this
map.
CCT NO 0302722
SE NO: 0003797
MAP NO: C 11 B J
OT NO: 0011 O
AME: DAVIS WILSON L &
HELEN B
DDR: J R 10 WILDLIFE CLUB
LANE
CTYST: 1 1TAYLORSVILLE NC
IPCD: 8681
DREF 1: 052313362008
[ACRES- ------] F480
[VAL: 114192
SUBDIV:
OCATN: LOT 30 SEC 7 CLT
DESCRIPTION: WILDLIFE CLUB LN
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