20061569 Ver 1_COMPLETE FILE_20060927

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Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
October 20, 2006
Katrina Hearn
2117 Horton Road
Knightdale, NC 27545
Subject Property:
Katrina Hearn
Lake Royale [030301, 28-31-(1), B, NSW]
Alan W. Klimek, P.E. Director
Division of Water Quality
DWQ Project # 06-1569
Franklin County
Approval of 401 Water Quality Certification and Authorization Certificate per the Tar-Pamlico
River Buffer Protection Rules (15A NCAC 2B.0259) with Additional Conditions
Dear Sir or Madam:
You have our approval, in accordance with the attached conditions and those listed below, to shade
0.00137 acres of open water (Lake Royale) below normal pool lake level to construct a seawall, as
described within your application dated September 23, 2006, and received by the N.C. Division of Water
Quality (DWQ) on September 27, 2006. After reviewing your application, we have decided that the
impacts are covered by General Water Quality Certification Number(s) 3495 (GC3495). The
Certification(s) allows you to use General Permit Number 80 when issued by the US Army Corps of
Engineers (USACE). This letter shall also act as your approved Authorization Certificate for impacts to
the protected riparian buffers per 15A NCAC 213 .0259. In addition, you should obtain or otherwise
comply with any other required federal, state or local permits before you go ahead with your project
including (but not limited to) Erosion and Sediment Control, and Non-discharge regulations. Also, this
approval to proceed with your proposed impacts or to conduct impacts to waters as depicted in
your application shall expire upon expiration of the 404 or CAMA Permit.
This approval is for the purpose and design that you described in your application. If you change your
project, you must notify us and you may be required to send us a new application. If the property is sold,
the new owner must be given a copy of this Certification and approval letter and is thereby responsible for
complying with all conditions. If total fills for this project (now or in the future) exceed one acre of
wetland or 150 linear feet of stream, compensatory mitigation may be required as described in 15A
NCAC 2H.0506 (h). This approval requires you to follow the conditions listed in the attached
certification and any additional conditions listed below.
Conditions of Certification:
1. Impacts Approved
The following impacts are hereby approved as long as all of the other specific and general
conditions of this Certification (or Isolated Wetland Permit) are met. No other impacts are
approved including incidental impacts:
Amount Approved (Units) Plan Location or Reference
Open Water Lake Royale) below NPL 0.00137 acres - filled Abbreviated A lication
401 Oversight/Express Review Permits Unit
1650 Mail Service Center, Ralegh, North Carolina 27699-1650
2321 Crabtree Boulevard, Suite 250, Raleigh, North Carolina 27604
Phone: [phone] FAX [phone] Internet htta://h2o.enr.state.nc.us/ncwetiands

An Equal Opportunity/Affirmative Acton Employer- 50% Recyded110% Post Consumer Paper
Katrina Hearn
Page 2 of 4
October 20, 2006
2. No Waste, Spoil, Solids, or Fill of Any Kind
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.
3. Erosion and sediment control practices must be in full compliance with all specifications governing
the proper design, installation and operation and maintenance of such Best Management Practices in
order to protect surface waters standards:
a. The erosion and sediment control measures for the project must be designed, installed,
operated, and maintained in accordance with the most recent version of the North Carolina
Sediment and Erosion Control Planning and Design Manual.
b. The design, installation, operation, and maintenance of the sediment and erosion control
measures must be such that they equal, or exceed, the requirements specified in the most
recent version of the North Carolina Sediment and Erosion Control Manual. The devices
shall be maintained on all construction sites, borrow sites, and waste pile (spoil) projects,
including contractor-owned or leased borrow pits associated with the project.
c. Sufficient materials required for stabilization and/or repair of erosion control measures and
stormwater routing and treatment shall be on site at all times.
4. 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 devices in wetlands and 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;
5. Diffuse Flow (No Review)
All constructed stormwater conveyance outlets shall be directed and maintained as diffuse flow at
non-erosive velocities through the protected stream buffers such that it will not re-concentrate before
discharging into a stream as identified within 15A NCAC 213.0233 (5). If this is not possible, it may
be necessary to provide stormwater facilities that are considered to remove nitrogen. This may require
additional approval from this Office.
6. Certificate of Completion
Upon completion of all work approved within the 401 Water Quality Certification or applicable
Buffer Rules, and any subsequent modifications, the applicant is required to return the attached
certificate of completion to the 401 Oversight/Express Review Permitting Unit, North Carolina
Division of Water Quality, 1650 Mail Service Center, Raleigh, NC, 27699-1650.
Violations of any condition herein set forth may result in revocation of this Certification and may result in
criminal and/or civil penalties. The authorization to proceed with your proposed impacts or to conduct
impacts to waters as depicted in your application and as authorized by this Certification shall expire upon
expiration of the 404 or CAMA Permit.
If you do not accept any of the conditions of this Certification (associated with the approved wetland or
stream impacts), 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
r,
AttU 111d riudi it
Page 3 of 4
October 20, 2006
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 Cyndi Karoly or Ian McMillan in the Central Office in
Raleigh at 919-733-1786 or Mike Horan in the DWQ Raleigh Regional Office at 919-7914200.
AWK/Um
Enclosures: Certificate of Completion
incerely, rjd"?
Alan W. Klimek, P.E.
cc: Mike Horan, DWQ Raleigh Regional Office
USACE Raleigh Regulatory Field Office
File Copy
Central Files
Dennis Godwin, 115 Lema Drive, Garner, NC 27529
Filename: 061569KatrinaHearn(Franklin)101_TPBR
'T ?QF WATFi9Q Michael F. Easley, Governor
0 William G. Ross Jr., Secretary
OD r- North Carolina Department of Environment and Natural Resources
Q ^C Alan W. Klimek, P.E. Director
Division of Water Quality
October 3, 2006
DWQ Project # 06-1569
Franklin County
CERTIFIED MAIL: RETURN RECEIPT REQUESTED a]A110T-
Dennis Godwin 1 0 1 g, O (o
115 Lema Drive ' J v
Garner, North Carolina 27529 _k? d
Subject Property: Katrina Hearn
Check Not Signed
n EQUES'I' FOR MORE-1*11 F ORMAT'I9N- -- - - -
? PERMITTING FEE MISSINGANCORRECT
? RETURN OF APPLICATION PACKAGE
Dear Mr. Godwin:
On September 27, 2006, the Division of Water Quality (DWQ) received your application dated
September 23, 2006 for the above referenced project. Please provide the following information so that
we may continue to review your project. Please see `Other' section for explanation.
Additional Information Requested:
? Water Quality Certification, See I. Processing, Item 2.. Please state which Permit
(Nationwide, Regional or General) number you intend to use. You may want to contact the
U.S. Army Corps of Engineers (USACE) to determine which permit they will allow you to ,
use.
? DWQ requires the name of an individual shown as "Owner/Applicant" to set up the project.
? The PCN Application failed to contain the Applicant/Agent's Signature and Date. See last
page of application. (Agent's signature-is valid only if an authorization letter from applicant is
provided).
? Water Body information not stated. See III Project Information, Item 7.
? Incorrect and/or missing wetland, intermittent-perennial stream and/or buffer impacts.
DWQ is unable to review this project without noted or corrected impacts reflected.
? Lack of permitting fee. Please note that beginning January 1, 1999, the N.C. General
Assembly passed legislation requiring payment of a fee for all 401 applications. The fee for
applications is $200 for projects impacting less than an acre of wetland and less than 150
linear feet of streams. For projects impacting one or more acres of wetland or 150 or more
feet of streams, the fee is $475.
401 Oversight/Express Review Permitting Unit
1650 Mail Service Center, Raleigh, North Carolina 27699-1650
2321 Crabtree Boulevard, Suite 250, Raleigh, North Carolina 27604
Phone: [phone] / FAX [phone] / Internet: http://h2o.enr.state.nc.us/ncwetlands
Noce Carolina
Nturally
An Equal Opportunity/Affirmative Action Employer - 50% Recycled/ 10% Post Consumer Paper

? Incorrect permitting fee amount. Please see above item. Your check # for $
is herein enclosed for fee correction. DWQ does not retain any payment unless it is in the
correct amount.
? A request for a modification of an issued permit requires re-submission of five (5) application
sets and appropriate fee. We have herein returned your modification request.
? Application was missing pages or sections of information. See Other section below.
® OTHER: Check # 1736 was unsigned. Please sign and return with a copy of this letter.
This letter only addresses the application review and does not authorize any impacts to wetlands, waters
or protected buffers. Please be aware that any impacts requested within your application are not
authorized (at this time)-by the DWQ. Please call Mr. Ian McMillan or Ms.-Cyndi Karoly at 919--733-
1786 if you have any questions regarding or would like to set up a meeting to discuss this matter.
Sincerely,
ZZ't-4
t? P
Cyndi Karoly, Supervisor
401 Oversight/Express Review Permitting Unit
CBK/ljd
Enclosures: Check # 1736 for $200
cc: File Copy + check copy
Central Files + check copy
Filename: 061569 Ka trinaHearn(Fra n klin)_Hold_Cknotsigned
_Z_ -%-.
D ?
Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
October 3, 2006
CERTIFIED MAIL: RETURN RECEIPT REQUESTED
Dennis Godwin
115 Lema Drive
Garner, North Carolina 27529
Subject Property: Katrina Hearn
Check Not Signed
? REQUEST FOR MORE INFORMATION
? PERMITTING FEE MISSING/INCORRECT
? RETURN OF APPLICATION PACKAGE
Dear Mr. Godwin:
Alan W. Klimek, P.E. Director
Division of Water Quality
DWQ Project # 06-1569
Franklin County
0-1- IF
On September 27, 2006, the Division of Water Quality (DWQ) received your application dated
September 23, 2006 for the above referenced project. Please provide the following information so that
we may continue to review your project. Please see `Other' section for explanation.
Additional Information Requested:
? Water Quality Certification, See I. Processing, Item 2.. Please state which Permit
(Nationwide, Regional or General) number you intend to use. You may want to contact the
U.S. Army Corps of Engineers (USACE) to determine which permit they will allow you to
use.
? DWQ requires the name of an individual shown as "Owner/Applicant" to set up the project.
? The PCN Application failed to contain the Applicant/Agent's Signature and Date. See last
page of application. (Agent's signature is valid only if an authorization letter from applicant is
provided).
? Water Body information not stated. See III Project Information, Item 7.
? Incorrect and/or missing wetland, intermittent-perennial stream and/or buffer impacts.
DWQ is unable to review this project without noted or corrected impacts reflected.
? Lack of permitting fee. Please note that beginning January 1, 1999, the N.C. General
Assembly passed legislation requiring payment of a fee for all 401 applications. The fee for
applications is $200 for projects impacting less than an acre of wetland and less than 150
linear feet of streams. For projects impacting one or more acres of wetland or 150 or more
feet of streams, the fee is $475.
401 Oversight/Express Review Permitting Unit
1650 Mail Service Center, Raleigh, North Carolina 27699-1650
2321 Crabtree Boulevard, Suite 250, Raleigh, North Carolina 27604
Phone: [phone] / FAX [phone] / Internet: httn•//h2o enr state nc.us/ncwetlands
Nono Carolina
Naturally
An Equal Opportunity/Affirmative Action Employer- 50% Recycled/10% Post Consumer Paper
:)
? Incorrect permitting fee amount. Please see above item. Your check # for $
is herein enclosed for fee correction. DWQ does not retain any payment unless it is in the
correct amount.
? A request for a modification of an issued permit requires re-submission of five (5) application
sets and appropriate fee. We have herein returned your modification request.
? Application was missing pages or sections of information. See Other section below.
® OTHER: Check # 1736 was unsigned. Please sign and return with a copy of this letter.
This letter only addresses the application review and does not authorize any impacts to wetlands, waters
or protected buffers. Please be aware that any impacts requested within your application are not
authorized (at this time) by the DWQ. Please call Mr. Ian McMillan or'Ms. Cyndi Karoly at 919-733-
1786 if you have any questions regarding or would like to set up a meeting to discuss this matter.
Sincerely,
/o-t-4
Cyndi Karoly, Supervisor
401 Oversight/Express Review Permitting Unit
CBK/ljd
Enclosures: Check # 1736 for $200
cc: File Copy + check copy
Central Files + check copy
Filename: 061569KatrinaHearn(Fran klin)_Hold_Cknotsigned
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Division of Water Quality
October 3, 2006
DWQ Project # 06-1569
Franklin County
CERTIFIED MAIL: RETURN RECEIPT REQUESTED
Dennis Godwin
115 Lema Drive
Garner, North Carolina 27529
Subject Property: Katrina Hearn
Check Not Signed
? REQUEST FOR MORE INFORMATION
? PERMITTING FEE MISSING/INCORRECT
? RETURN OF APPLICATION PACKAGE
Dear Mr. Godwin:
On September 27, 2006, the Division of Water Quality (DWQ) received your application dated
September 23, 2006 for the above referenced project. Please provide the following information so that
we may continue to review your project. Please see `Other' section for explanation.
Additional Information Requested:
? Water Quality Certification, See I. Processing, Item 2.. Please state which Permit
(Nationwide, Regional or General) number you intend to use. You may want to contact the
U.S. Army Corps of Engineers (USACE) to determine which permit they will allow you to
use.
? DWQ requires the name of an individual shown as "Owner/Applicant" to set up the project.
? The PCN Application failed to contain the Applicant/Agent's Signature and Date. See last
page of application. (Agent's signature is valid only if an authorization letter from applicant is
provided).
? Water Body information not stated. See III Project Information, Item 7.
? Incorrect and/or missing wetland, intermittent-perennial stream and/or buffer impacts.
DWQ is unable to review this project without noted or corrected impacts reflected.
? Lack of permitting fee. Please note that beginning January 1, 1999, the N.C. General
Assembly passed legislation requiring payment of a fee for all 401 applications. The fee for
applications is $200 for projects impacting less than an acre of wetland and less than 150
linear feet of streams. For projects impacting one or more acres of wetland or 150 or more
feet of streams, the fee is $475.
I tltcaroln
401 Oversight/Express Review Permitting Unit QlllCll??
1650 Mail Service Center, Raleigh, North Carolina 27699-1650
2321 Crabtree Boulevard, Suite 250, Raleigh, North Carolina 27604
Phone: [phone] / FAX [phone] / Internet: http://h2o.enr.state.nc.us/ncwetiands
An Equal Opportunity/Affirmative Action Employer - 50% Recycled/10% Post Consumer Paper
I,
? Incorrect permitting fee amount. Please see above item. Your check # for $_
is herein enclosed for fee correction. DWQ does not retain any payment unless it is in the
correct amount.
? A request for a modification of an issued permit requires re-submission of five (5) application
sets and appropriate fee. We have herein returned your modification request.
? Application was missing pages or sections of information. See Other section below.
® OTHER: Check # 1736 was unsigned. Please sign and return with a copy of this letter.
This letter only addresses the application review and does not authorize any impacts to wetlands, waters
or protected buffers. Please be aware that any impacts requested within your application are not
authorized (at this time) by the DWQ. Please call Mr. Ian McMillan or Ms. Cyndi Karoly at 919-733-
1786 if you have any questions regarding or would like to set up a meeting to discuss this matter.
Sincerely,
Po-t-4
Cyndi Karoly, Supervisor
401 Oversight/Express Review Permitting Unit
CBK/ljd
Enclosures: Check # 1736 for $200
cc: File Copy + check copy
Central Files + check copy
Filename: 061569KatrinaHearn(Franklin)_Hold_Cknotsigned
Personal Account Information Redacted
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Office Use Only: Tcmm Version August 2006
USACE Action ID No. DWQ No. ()
(If any particular item is not applicable to this
1. Applicant Information
1. Owner/Applicant
Name:- -?
Mailing Address:
Telephone Number:
E-mail Address: '

2. Agent/Consultant Information (.A signed and dated copy of the Agent Authorization letter must be
attached if the Agent has signatory authori;ty for the owner/applicant.)
Name: 2e.10101 5 G0CL LU-, M
Company Affiliation:
Mailing Address: 11 S t-e.M.a- Q R
GD'_ - Svc a) S ag
Telephone Number.: C t t Q - U 'a%G 3 12 t, Fax Nur_?ber: `"
E-mail Address: 2
11. Project Information
oec? DO
206
OENR - WATER QUALITY
WETLANDS AND STORMWATER BRANCH
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.
;~or administrative and distribution purposes, the USACE requires information to be submitted on sheets
no larger than 11 by 17-inch format; however, DW Q 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 tivill be informed
the, the project has been placed on hold until decipherable maps are provided.
t. Location
County:- rr?Y Ian Nearest Town: 2
Subdivision ?_
name (include phaseflot number): V-- G? F'
Site coordinates: ow
Decimal Degrees (6 digits minimum): °N
Directions to site (include road numbers/names, landmarks, etc.):.-
-
t
please enter "Not Applicable" or "NIA".)
Page 2 of 4

2. Describe the existing conditions on the site and general land use in the vicinity of the project at the
time o`LMs application:- C2, + c1k __
3. Property size (acres): (p
4. Name of nearest named receiving body of water(strearn/river!iake):_ La,1C? Ca e .
5. Describe the purpose of the proposed work:
5. List the type of equipment to be used to construct the project:
7. T}Te and amount of impact (including all back fill, excavation, riprap, retaining walls, other fill,
etc.) below the normal pool laic level in square feet or acres. and distance from shoreline:
b. a. Type and amount of impact (including all clearing, back fill, excavation, riprap, retaining walls,
other fill, etc.) above the normal pool lak leAel and 50 feet land--ward in square feet or acres:
b. Please describe the vegetation above the normal pool lake level and 50 £eet land-ward to be
impacted (number of trees for instance): CNI
i. ?
)6?-
F - Date
Applicant/Agent's Signature
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
Page 3 of 4

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Office Use Only: Fur;sz ?ersion August 2OA6
USACE Action ID No. DWQ No. 0 0 6 i
(If any particular item is not applical,le to this project, please enter "Nc, /Lpplicab!e?' or "NIA".)
T. Applicant Information
I. Owner/Applicant Itiformation '-' -
Mailing Address:
Telephone Number: ' JD--YD, 4 F
E-mail Address: v_-_, ?t- re-C
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 ourner/applicant.)
Name: 6Je r'.) rm C1aLuM rz -
Company Affiliation: _
---
Mailing Address: 1 rz 1„ztA a... Q P,
Cst
Telephone Number: alQ- 6 aS - 312ro Fax Number: ,5V 12
E-mail Address: -
SEP 2 7 2006
Ill. Project Information
OENR -WATER QUALITY
S o STOM
Attach a vicinity neap clearly showing the location of the property with respect to local Ianmaar cs 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 MRCS Soil Survey with *,e 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. Location
County: PrCvN1C N r, - Nearest Town:
Subdivision name (include phase/lot number):___?-
Site coordinates:
Decimal Degrees (b digits zninimiun): °N °W
Directions to site (include road nurnbers/names, landmarks, etc.): ,t

Page 2 of 4
{ .,%
f
2. Describe the existing c-,--nditioais on tl•.r..cit:. and Fzcncrr_} ]and in the -vicirdty of the project at the
time of this application.
__?i?,??'S
3. Property size (acres): _ ) ?- 1C?C?
1. W 4. Name of nearest named receivii)i body of w tter(stre -m,ritrer,'lake):__,. ---
5. Describe the purpose of the proposed work:?kZ V--Ci , "'kNj,!lLN-D'Z-?
6. List the type of equipment to be used to construct the project:
7. Type and amount of impact (including all back fill, excavWion, riprap, retaining walls, other fili,
etc.) below the normal pool lake level in square feet or acres, and distane.- from shoreline:
8, a. Type and amount of impact (including all clearing, back fill, excavation, riprap, retaining walls,
other fill, etc.) above the normal pool lakq le,Xel and 50 feet lathd-ward in square feet or acres:
b. Please describe the vegetation above the normal pool lake level and 50 feet land-ward to be
impacted (number of trees for instance): „S &-..- \- .} i ki.

T Applicant/Agent's Signature Date
(Agent's signature is valid only if an authorizat. on letter from the applicant is provided.)
Page 1 of 4
,a
1 ?
i
i

'I._
Office Use Only:
USACE Action ID No.
any
Porn Version August 2006
item is not applicable to this project, please enter "Not Applicable" or "N/A".)
1. Applicant Information
1. Owner/Applicant I formation
Name: Lam'. ?L -;f
Mailing Address: &Ei t? t6n A _
Telephone Number Fax Number:
E-mail Address: ?1 c1 Kir1 ren l h, i ( h
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 owner/applicant.)
She. N N w ?oolu:rvr? __
Name:
Company Affiliation:
Mailing Address: t \ S LfetA a t) y.
GAG_ rne.rz N C. 'r) s 2 q
Telephone Number: O? N q - 1c a, S___
E-mail Address:
009 ,
S Ep 2 7 2006
11. Project Information DENR_wti
NEf (ANDS AND S
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 MRCS 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. Location T
County: Pr",- 1N" Nearest Town:
Subdivision name (include phase/lot number): 1- CUNIu, _ .?
Site coordinates:
Decimal Degrees (6 digits minimum): `N _ OW
Directions to site (include road numbers/names, landmarks, etc.):
t
No.
Fax Number:
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'. Describe, the existing conditions on the site and general land use in the vicinity of the project at the
time of this application.
3. Property size (acres): (00--- IZ)0 _
4. Name of nearest named receiving body of water(stream/river/take): aoC Q. NA -
rill
5. Describe the purpose of the proposed work: JUA
6. List the type of equipment to be used to construct the project:--CNR ??
7. Type and amount of impact (including all back fill, excavation, riprap, retaining walls, other fill,
etc.) below the normal pool lake level in square feet or acres, and distance from shoreline:
S. a. Type and amount of impact (including all clearing, back fill, excavation, riprap, retaining walls,
other fill, etc.) above the normal pool lak I el and 50 feet land-ward in square feet or acres:
b. Please describe the vegetation above the normal pool lake level and 50 feet land-ward to be
??-?•
impacted (number of trees for instance): zc?
C'Zr. - .1 .. i tZ r-.\ e, [r-, t C'N --

Otk-,,?)61,
Applicant/Agent's Signature Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
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