20060762 Ver 1_COMPLETE FILE_20060508

Mr. Russ Willard
Parks-Hubbard-Ramey
P. 0. Box 10
Bethania, NC 27010

APPROVAL of 401 Watei Quality Certification with Additional Conditions
Dear Mr. Willard:
Parks-Hubbard-Ramey has our approval, in accordance with the attached conditions, to conduct stream
restoration and stabilization activities along a total of 53 linear feet of an unnamed tributary to Muddy Creek
located in the Lockhurst S lbdivision in Winston-Salem, Forsyth County as described in your application
received by the Division c "Water Quality on May 8, 2006. After reviewing your application, we have
determined that this activit, is covered by General Water Quality Certification Number 3495, which can be
viewed on our web site at h tp://www.ncwaterquality.org/wetlands.html. This Certification allows you to use.
Nationwide Permit Numbe. 27 when it is issued by the U.S. Army Corps of Engineers. In addition, you
should secure any other aj plicable federal, state or local permits before you proceed with your project,
including (but not limited those required by Sediment and Erosion Control, Non-Discharge, and Water
Supply Watershed regulatii is. Also, this approval will expire when the accompanying 404 permit expires
unless otherwise specified is the General Certification.
This approval is valid only for the purpose and design that you have described in your application. If you
change your project, you mi st notify us in writing, and you may be required to send us a new application for a
new certification. If the r •operty is sold, the new owner must be given a copy of the Certification and
approval letter and is therel y responsible for complying with all conditions. For this approval to be valid,
you must follow the con& :ions listed in the attached certification, as well as the additional conditions
listed below:
1. The following impact' are hereby approved as long as all other specific and general conditions of this
Certification are met. 1o other impacts, including incidental impacts, are approved:
Amount A ri ved
Streams 53 linear fe(
Plan Location or Reference
Unnamed tributary to Muddy Creek located in the Lockhurst
Subdivision in Winston-Salem, Forsyth County as shown on the
vicinity map included with the Pre-Construction Notification
North Carolina Division of Water Quality
Wetlands Certification Unit
Customer Service Number: 1-877-62
An Equal Opportunity/Affirmative Action E
Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Alan W. luimek, P.E. Director
- Division of Water Quality
May 12, 2006
DWQ# 06-0762
Forsyth County
Nco ` Carolina
Naturally
1650 Mail Service Center Raleigh, NC 27699-1650 Phone [phone] FAX [phone]
2321 Crabtree Blvd. Raleigh, NC 27604-2260 Internet http:/Iwww.ncwaterguality.org
-6748
ployer - 50% Recycled/10% Post Consumer Paper
Mr. Russ Willard
Page 2, DWQ# 06-0762
May 12, 2006
2. Appropriate sediment and erosion control measures which equal or exceed those outlined in the most
recent version of the North Carolina Erosion and Sediment Control Planning and Design Manual or the
North Carolina Surface Mining Manual (available from the Division of Land Resources at NCDENR
regional offices or the central office), whichever is more appropriate, shall be designed, installed and
maintained properly to assure compliance at all times with the North Carolina water quality standards
that are applicable to Class C waters as described in 15A NCAC 02B.0211 Fresh Surface Water Quality
Standards For Class C Waters. Such measures must equal or exceed the requirements specified in the
most recent version of the North Carolina Sediment and Erosion Control Manual. These measures must
be maintained on all construction sites, borrow sites, and waste pile (spoil) sites, including contractor
owned and leased borrow pits, which are associated with the project.
3. Sediment and erosion control measures shall not be placed in wetlands or waters to the maximum extent
practicable. If placement of sediment and erosion control measures in wetlands or waters is
unavoidable, they shall be removed and the natural grade restored within six months of the date that the
Division of Land Resources has released the project.
4. No waste, spoil, solids, or fill of any kind shall occur in wetlands, waters, or riparian areas beyond the
footprint of the impacts depicted in the Pre-Construction Notification. All construction activities,
including the design, installation, operation, and maintenance of sediment and erosion control "Best
Management Practices" shall be performed so that no violations of state water quality standards,
statutes, or rules occur.
Upon finishing the project, the Applicant shall fill out and return the enclosed "Certificate of
Completion" to notify NCDWQ when all work included in the §401 Certification has been completed.
This certificate should be returned to the 401/Wetlands Unit of the NC Division of Water Quality at the
address listed on the form. Along with the Certificate of Completion, please send photographs showing
all restored stream reaches.
If you do not accept any of the conditions of this certification, you may ask for an adjudicatory hearing. You
must act within 60 days of the date that you receive this letter. To ask for a hearing, send a written petition
which conforms to Chapter 150B of the North Carolina General Statutes to the Office of Administrative
Hearings, 6714 Mail Service Center, Raleigh, N.C. 27699-6714. This certification and its conditions are final
and binding unless you ask for a hearing.
This letter completes the review of the Division of Water Quality under Section 401 of the Clean Water Act.
If you have any questions, please telephone Daryl Lamb in the DWQ Winston-Salem Regional Office at (336)
771-4959 or Ian McMillan in the Central Office in Raleigh at [phone].
Sincerely,
Alan W. Klimek, P.E.
AWK/cdl
Mr. Russ Willard
Page 3, DWQ# 06-0762
May 12, 2006
Attachments
cc: Mr. John Thomas, U. S. Army Corps of Engineers, Raleigh Regulatory Field Office
Winston-Salem DWQ Regional Office
Central Files
Wetlands/401 File Copy
WSRO 401 GWQC Authorizations
Subject: WSRO 401 GWQC Authorizations
From: Daryl Lamb <[e-mail]>
Date: Mon, 15 May 200616:40:51 -0400
To: Ian McMillan <[e-mail]>
CC: Laurie J Dennison <[e-mail]>
Ian and Laurie,
The following 401 authorizations have been issued by WSRO:
06-0561: Town of Jefferson WWTF (Ashe), issued 05/11/2006;
06-0645: Duke Energy-Belews Creek Ash Landfill (Stokes), issued 05/11/2006;
06-0716: Hanes Square Circle-Wall Repair (Forsyth), issued 05/12/2006;
06-0748: Jordan Property Stream Restoration (Davidson), issued 05/12/2006;
06-0762: Lockhurst Subdivision Stream Stabilization (Forsyth), issued 05/12/2006.
Best regards,
Daryl
Daryl Lamb
NC DENR Winston-Salem Regional Office
Division of Water Quality
Winston-Salem, NC 27107
Voice: [phone]
FAX: [phone]
Daryl Lamb <Daryl.Lamb(a,NCmail.net>
WSRO
NC DENR
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1 of 2 5/15/2006 4:41 PM
Triage Check List
Date: 5/10/06

Daryl Lamb, Winston-Salem Regional Office
To:
60-day processing time: 5/08/06 - 7/06/06
From: Cyndi Karoly Telephone: [phone]
Project Name: Lochurst SD
DWQ#: 06-0762
County: Forsyth
The file attached is being forwarded to you for your evaluation.
Please call if you need assistance.
? Stream length impacted
? Stream determination
Wetland determination and distance to blue-line surface waters on USFW topo maps
? Minimization/avoidance issues
? Buffer Rules (Meuse, Tar-Pamlico, Catawba, Randleman)
? Pond fill
Mitigation Ratios
? Ditching
? Are the stream and or wetland mitigation sites available and viable?
? Check drawings for accuracy
Is the application consistent with pre-application meetings?
? Cumulative impact concern
Comments: As per our discussion regarding revision of the triage and delegation processes,
please review the attached file. Note that you are the first reviewer, so this file will need to be
reviewed for administrative as well as technical details. If you elect to place this project on hold,
please ask the applicant to provide your requested information to both the Central Office in
Raleigh as well as the Asheville Regional Office. As we discussed, this is an experimental, interim
procedure as we slowly transition to electronic applications. Please apprise me of any
complications you encounter, whether related to workload, processing times, or lack of a "second
reviewer" as the triage process in Central had previously provided. Also, if you think of ways to
improve this process, especially so that we can plan for the electronic applications, let me know.
Thanks!
.r
?ofy,
?0
`B? j1} lY-1 ]t-jam
May 4, 2006
200E0762
i
North Carolina Division of Water Quality
.401 /Wetlands Unit
1650 Mail Service Center
Raleigh, NC 27699-1650
Please find enclosed seven (7) copies of an application for a NW 27 permit for the
above-referenced subdivision project. This site is located just northwest of the Winston-
Salem, NC city limits and we hope to implement the activities authorized by this permit
immediately. The N.C. Division of Water Quality has requested that the stream segment
indicated in this permit be stabilized. Should you wish to visit the property, I would be
happy to meet you and take you to the area of the proposed stream stabilization. Please
contact me if you have any questions or if you require any additional information. I may
be contacted on my cell phone at 336-655-7339. Thank you for your assistance in this
matter.
Very truly yours,
Russ Willard
Ramey, Inc.
P?qf ? lt?Ub
OENR - vVAI ER QUALITY
Vi1ETI}MS At4D STORMINATER ARANC}i
P.O. Box 10 - Bethania, NC 27010-0010 - 336-922-4000 - Fax [phone]
Office Use Only:
USAGE Action ID No. DWQ No.
Form Version May 2002
(If any particular item is not applicable to this project, please enter "Not Applicable" or "N/A".)
L Processing A. I I -+ ? T
RECEIVED
1. Check all of the approval(s) requested for this pro ect:
© Section i404 Permit [)] Riparian or Watershed Buffer Rules
? Section X10 Permit ? Isolated Wetland Permit from DWQ
401 Water Quality Certification
I
2. Nationwide, Regional or General Permit Number(s) Requested: 27
3. If this notification is solely a courtesy copy because written approval for the 401 Certification
is not required, check here: ?
4. If payment into the North Carolina Wetlands Restoration Program (NCWRP) is proposed for
mitigation of impacts (verify availability with NCWRP prior to submittal of PCN), complete
section VIII and check here: ?
5. If your project is located in any of North Carolina's twenty coastal counties (listed on age
4), and the project is within a North Carolina Division of Coastal Man of
Environmental Concern (see the top of page 2 for further details ITINt
H. Applicant Info rmation
1. Owner/Applicant Information Russ Willard WAS;R Aob?
Name: Parks-Hubbard-Ramey _O? ANO ST
Mailing Address: P. o. Box 10
Bethania, NC 27010
I
I
Telephone Number:336-922-4000 Fax Number.--.L36-922-1762
E-mail Address: [e-mail]
2. Agent/Consultant Information (A signed and dated copy of the Agent Authorization letter
must be attached if the Agent has signatory authority for the ownerlapplicant.)
Name:
Company Affiliation:
Mailing Address:
I
Telephone Number: Fax Number.
E-mail Address:
Page 5 of 12
III. 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. Both the vicinity map
and site plan must include a scale and north arrow. The specific footprints of all buildings,
impervious surfaces, or other facilities must be included. If possible, the maps and plans should
include the appropriate USGS Topographic Quad Map and NRCS Soil Survey with the property
boundaries outlined Plan drawings, or other maps may be included at the applicant's discretion,
so long as the property is clearly defined For administrative and distribution purposes, the
USACE requires information to be submitted on sheets no larger than 11 by 17-inch format;
however, DWQ may accept paperwork of any size. DWQ prefers full-size construction
drawings rather than a sequential sheet version of the full-size plans. If full-size plans are
reduced to a small scale such that the final version is illegible, the applicant will be informed that
the project has been placed on hold until decipherable maps are provided
1. Name of project: Lochurst Subdivision
2. T.I.P. Project Number or State Project Number (NCDOT Only):
3. Property Identification Number (Tax PN- 5898900860
4. Location
County: Forsyth Nearest Town: Pfafftown
Subdivision! name (include phasellot number): Lochurst Subdivision, Section IV, Phase
Directions to site (include road numbers, landmarks, etC.): From Pfafftown, NC approximately
1/4 mile west on Yadkinville Highway to right on Transou Road to right
on Pebble Lake Drive
5. Site coordinates, if available (UTM or Lat/Long): TM36° 9.8301 W80 ° 21 .535 1
(Note - If project is linear, such as a road or utility line, attach a sheet that separately lists the
coordinates' for each crossing of a distinct waterbody.)
6. Property size (acres): (Sec IV, Ph 2) -- 15.65 AC +/-
7. Nearest body of water (stream/river/sound/ocean/lake): Lochurst Pond
8. River Basin Yadkin-PeeDee
(Note - this must be one of North Carolina's seventeen designated major river basins. The
/.)
River Basin' map is available at hiip://h2o.enr.state.nc.us/admin/mi!ps
9. Describe the existing conditions on the site and general land use in the vicinity of the project
at the time of this application: Residential Subdivision
Page 6 of 12
10. Describe the overall project in detail, including the type of equipment to be used: stream
stabilization Project.. Removal of vegetative debris, fallen trees, -
in-stream riser pipe and rock check dam. Repairs to be done with
backhoe, skid-steer and all-terrain 6 CY truck
11. Explain the purpose of the proposed work. Stabilization of approximately 300 LF
of stormwater conveyance channel & intermittent stream.
IV. Prior Project History
if jurisdictional determinations and/or permits have been requested and/or obtained for this
project (including all prior phases of the same subdivision) in the past, please explain. Include
the USACE Action ID Number, DWQ Project Number, application date, and date permits and
certifications were issued or withdrawn. Provide photocopies of previously issued permits,
certifications of other useful information. Describe previously approved wetland, stream and
buffer impacts, along with associated mitigation (where applicable). If this is a NCDOT project,
list and describe permits issued for prior segments of the same T.I.P. project, along with
construction schedules.
Installation of in-stream riser pipe and sediment basin was authorized
by NW #26 permit in 1995 Copy of permit not available
V. Future Project Plans
Are any future permit requests anticipated for this project? If so, describe the anticipated work,
and provide justification for the exclusion of this work from the current application.
No other permits are anticipated.
VI. Proposed Impacts to Waters of the United States/Waters of the State
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
wetlands, open `water, and stream channels associated with the project. The applicant must also
provide justification for these impacts in Section VII below. All proposed impacts, permanent
and temporary, must be listed herein, and must be clearly identifiable on an accompanying site
plan. All wetlands and waters, and all streams (intermittent and perennial) must be shown on a
delineation map, whether or not impacts are proposed to these systems. Wetland and stream
evaluation andj delineation forms should be included as appropriate. Photographs may be
included at thei applicant's discretion. If this proposed impact is strictly for wetland or stream
mitigation, list and describe the impact in Section VIII below. If additional space is needed for
listing or description, please attach a separate sheet
Page 7 of 12
1. Provide a written description of the proposed impacts: The existing debris dam in-stream
riser basin' and rock check dam will be removed and replaced by rock step
pools which! shall be utilized as grade control devices.
2. Individually list wetland impacts below:
Wetland Impact

Site Number-
Site
indicate on ma + -

Type of Impacts
C Area of

Impact
acres Located within ---_-

100-year Floodplain**
es/no -. Distance -to---

Nearest Stream
linear feet
-
Type of Wetland***

I

Llst earn impact separately ann rpentuy temporary Impacts. Impacts include, but are not limited to: mechanized cleating, grading, fill,
excavation, flooding, ditching/drainage, etc. For dams, separately list impacts due to both structure and flooding.
** 100-Year floodplains arc identified through the Federal Emergency Management Agency's (FEMA) Flood Insurance Rate Maps
(FIRM), or FEMA-approved local floodplain maps. Maps are available through the FEMA Map Service Center at I-800-358-9616, or
online at litto://www.fema.itov.
List a wetland type that best describes wetland to be impacted (e.g., freshwatedsaltwater marsh, forested wetland, beaver pond,
Carolina Bay, bog, etc.) Indicate if wetland is isolated (determination of isolation to be made by USACE only).
List the total acreage (estimated) of all existing wetlands on the property:
Total area of wetland impact proposed:. i
3. Individually list all intermittent and perennial stream impacts below:
Stream Impact
Site Number
indicate on ma
Type of Impact* Length of
Impact
linear feet
Stream Name" Average Width
of Stream
Before Li pact Perennial or
Intermittent?
lease specify)
Structure 1 Ste Pool .8' T to Lochurst Pon 21-3' Intermittent
Structure 2 Step Pool 20' T to Lochurst Pon 21-3' Intermittent
-- - ----
Structure 3 ---------- - ---- -
Ste Pool ---- -------
25' ----------- - -------
T to Lochurst Pon --------- - - --
21-3' - -- -- -- - ----
Intermittent

" last each impact separately and identity temporary impacts. Impacts include, but are not limited to: culverts and associated rip-rap,
dams (separately list impacts duo to both structure and flooding), relocation (include linear flat before and after, and net losslgain),
stabilization activities (cement wall, rip-rap, crib wall, gabiops, etc.), excavation, ditching/straightening, etc. If stream relocation is
proposed, plans and profiles showing the linear footprint for both the original and relocated streams must be included.
Stream names can be found on USGS topographic maps. If a stream has no name, list as UT (unnamed tributary) to the nearest
downstream named stream into which it flows. USGS maps are available through the USGS at 1-800-358.9616, or online at
www.uses.eov. Several; internet sites also allow direct download and printing of USGS maps (e.g., www.topozone.com.
www.manauest.com. etc.).
Cumulative impacts (linear distance in feet) to all streams on site: 53' +/-
Page 8 of 12
4. Individually list all open water impacts (including lakes, ponds, estuaries, sounds, Atlantic
ocean and any other water of the U.S.) below:
Qgen Water Impact
Site Number-
indicate on ma
Type of Impact$ Area of
Impact
acres
Name Wat
-
(if
applicable) Type of Waterbody
(lake, pond, estuary, sound,
bay, ocean, etc.
I

?I
* List each impact separately and identify temporary impacts. Impacts include, but are not limited to: fill, excavation, dredging,
flooding, drainage, bulkheads, etc.
5. Pond Creation N/A
If construction of a pond is proposed, associated wetland and stream impacts should be
included above in the wetland and stream impact sections. Also, the proposed pond should
be described here and illustrated on any maps included with this
II. cation.
Pond to be created in (check all that apply): ? uplands stream ? wetlands
app
Describe the method of construction (e.g., dam/embankment, excavation, installation of
draw-down valve or spillway, etc.):
Proposed use or purpose of pond (e.g., livestock watering, irrigation, aesthetic, trout pond,
local stormwater requirement, etc.):
Size of watershed draining to pond: Expected pond surface area:
VII. Impact Justification (Avoidance and Minimization)
Specifically describe measures taken to avoid the proposed impacts. It may be useful to provide
information related to site constraints such as topography, building ordinances, accessibility, and
financial viability of the project. The applicant may attach drawings of alternative, lower-impact
site layouts, and explain why these design options were not feasible. Also discuss how impacts
were minimized once the desired site plan was developed If applicable, discuss construction
techniques to be followed during construction to reduce impacts.
At the request of N.C. Division of Water Quality, the impacts have been
deemed necessary to reduce degradation of the stream channel.
VIII. Mitigation
DWQ - In accordance with 15A NCAC 2H .0500, mitigation may be required by the NC
Division of Water Quality for projects involving greater than or equal to one acre of impacts to
freshwater wetlands or greater than or equal to 150 linear feet of total impacts to perennial
streams.
Page 9 of 12
USAGE - In ! accordance with the Final Notice of Issuance and Modification of Nationwide
Permits, published in the Federal Register on March 9, 2000, mitigation will be required when
necessary to ensure that adverse effects to the aquatic environment are minimal. Factors
including size and type of proposed impact and function and relative value of the impacted
aquatic resource will be considered in determining acceptability of appropriate and practicable
mitigation as proposed Examples of mitigation that may be appropriate and practicable include,
but are not limited to: reducing the size of the project; establishing and maintaining wetland
and/or upland vegetated buffers to protect open waters such as streams; and replacing losses of
aquatic resource functions and values by creating, restoring, enhancing, or preserving similar
functions and f slues, preferable in the same watershed
If mitigation is required for this project, a copy of the mitigation plan must be attached in order
for USACE or DWQ to consider the application complete for processing. Any application
lacking a required mitigation plan or NCWRP concurrence shall be placed on hold as
incomplete. An applicant may also choose to review the current guidelines for stream restoration
in DWQ's Draft Technical Guide for Stream Work in North Carolina, available at
htro://h2o. enr.state.nc. us/ncwetlands/strmgide.html.
1. Provide a brief description of the proposed mitigation plan. The description should provide
as much information as possible, including, but not limited to: site location (attach directions
and/or map, if offsite), affected stream and river basin, type and amount (acreage/linear feet)
of mitigation proposed (restoration, enhancement, creation, or preservation), a plan view,
preservation mechanism (e.g., deed restrictions, conservation easement, etc.), and a
description,of the current site conditions and proposed method of construction. Please attach
a separate sheet if more space is needed.
N/A
I
I
2. Mitigation may also be made by payment into the North Carolina Wetlands Restoration
Program (NCWRP). Please note it is the applicant's responsibility to contact the NCWRP at
(919)733-5 ' 208 to determine availability and to request written approval of mitigation prior
to submittal of a PCN. For additional information regarding the application process for the
NCWRP, check the NCWRP website at h9p://h2o.enr.state.nc.us/wrp/index.htm. If use of
the NCWRP is proposed, please check the appropriate box on page three and provide the
following information: N/A
Amount of stream mitigation requested (linear feet):
Amount of buffer mitigation requested (square feet):
Amount 'of Riparian wetland mitigation requested (acres):
Amount 'of Non-riparian wetland mitigation requested (acres):
Amount of Coastal wetland mitigation requested (acres):
Page 10 of 12
IX. Environmental Documentation (required by DWQ)
Does the project involve an expenditure of public (federal/state) funds or the use of public
(federal/state) land?
Yes ? No Q
If yes, does the project require preparation of an environmental document pursuant to the
requirements of the National or North Carolina Environmental Policy Act (NEPA/SEPA)?
Note: If you are not sure whether a NEPA/SEPA document is required, call the SEPA
coordinator at [phone] to review current thresholds for environmental documentation.
Yes ? No ?
If yes, has the document review been finalized by the State Clearinghouse? If so, please attach a
copy of the NEPA or SEPA final approval letter.
Yes ? No ?
X. Proposed Impacts on Riparian and Watershed Buffers (required by DWQ)
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
required state and local buffers associated with the project. The applicant must also provide
justification for these impacts in Section VII above. All proposed impacts must be listed herein,
and must be clearly identifiable on the accompanying site plan. All buffers must be shown on a
map, whether or not impacts are proposed to the buffers. Correspondence from the DWQ
Regional Office may be included as appropriate. Photographs may also be included at the
applicant's discretion.
Will the project impact protected riparian buffers identified within 15A NCAC 2B .0233
(Meuse), 15A NCAC 2B .0259 (Tar-Pamlico), 1SA NCAC 2B .0250 (Randleman Rules and
Water SuppI Buffer Requirements), or other (please identify l?
Yes] No Q If you answered "des", provide the following information:
Identify the square feet and acreage of impact to each zone of the riparian buffers.- If buffer
mitigation is required calculate the required amount of mitigation by applying the buffer
multipliers.

Zone.
s feet
Multiplier Regatred
K ' tion
1 3
12
Total
« Zone i extends out 30 feet perpendicular from near bank of channel; Zone 2 extends an
additional 20 feet from the edge of Zone 1.
Page I1 of 12
If buffer mitigation is required, please discuss what type of mitigation is proposed (i.e., Donation
of Property, Conservation Easement, Riparian Buffer Restoration / Enhancement, Preservation or
Payment into the Riparian Buffer Restoration Fund). Please attach all appropriate information as
identified within 15A NCAC 2B.0242 or.0260.
XI. Stormwater (required by DWQ)
Describe impervious acreage (both existing and proposed) versus total acreage on the site.
Discuss storm water controls proposed in order to protect surface waters and wetlands
downstream from the property.
N/A
XH. Sewage Disposal (required by DWQ)
Clearly detail the ultimate treatment methods and disposition (non4scharge or discharge) of
wastewater gen) rated from the proposed project, or available capacity of the subject facility.
N/A
XM. Violations (required by DWQ)
is this site in violation of DWQ Wetland Rules (15A NCAC 2H.0500) or any Buffer Rules?
Yes Q No El
Is this an after-the-fact permit application?
Yes ?, No 12
XIV. Other Circumstances (Optional):
It is the applicant's responsibility to submit the application sufficiently in advance of desired
construction dates to allow processing time for these permits. However, an applicant may
choose to list constraints associated with construction or sequencing that may impose limits on
work schedules (e.g., draw-down schedules for lakes, dates associated with Endangered and
Threatened Species, accessibility problems, or other issues outside of the applicant's control).
'0c;-
Applicant/Agent's Signature Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
Page 12 of 12
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3
RAMEY, INC. • WINSTON-SALEM, NC 27106
INVOICE NO. INVOICE DATE DESCRIPTION GROSS AMOUNT DISCOUNT
584 5-4-06 Lochurst NW27 Permit 200.00 200.00
TOTALS
200.00
200.00