20181647 Ver 1_Shoreline Stabilization_20181203

h " State of North Carohn};,
Department of Environment and Natural Resources® I
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Division of Water Resources
15A NCAC 02H .0500 — Water Quality Certification, Shoreline Stabilization
FORM: SSGP 02-2017
Shoreline Stabilization Application Form 2 0 1 8 1 6 4 7
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 PermK40J&_B 1617 Mail Service Center 512 N. Salisbury Streeta �/J�
Raleigh, NC 27699-1617 Raleigh, NC 27604 1VJ 0
U 3 2018
A. Applicant Information 115A NCAC 02H .0502(a)]
1. Owner Information R ESOU S
Name: J U i , u R P I
Mailing Address:
Telephone Number: R(q SSC - y `i't ,"L Fax Number: n�
E-mail Address:
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.mii/Portals/59/docs/regulatoryjregdocs/Permits/SAMPLE AGENT AUTHORIZ
ATION FORM.pdf) /� J Name: _Sf p V4 9- , < Lc,.,,
Company Affiliation: P {� , l S qua
Mailing Address: q
Telephone Number:- ��u_ 6 Y-3 Fax Number
E-mail Address: ,ocz n.
B. Project Information [15A 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 plan 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

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 of the property (where work is to be conducted)
County: Frurk 1,'1y Nearest Town: 13ZI n Xti
Lake/ river/ ocean adjacent to property: / p d oy a L �p
Property size (acres):
Subdivision name or site address (include phase/lot number): _L u /L z ho
Directions to site - please include road .,
names and numbers, landmarks, etc.: t`j,, ,,.1 t9 A t;
J} p�
C�14 1. R /�/'—S�>4! _Z AK 7L r11 11 ivi2f [ac L ( hfy-o?dk .` M,k 1 f �yf l-' says /{%r ,
Latitude (in decimal degrees) -714,+ Longitude (decimal degrees) 44 l �erhr
5. Describe the existing land use or condition of the site at the time of this application
(residential. undeveloped, etc.): ): ��s�4uw, 1r;t a-- "V-\ %ZLs✓ /3rrh
6. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): Fc 5 tk, r
1�_er_v
7. Will work be conducted from land? D From water? 0
8. Total amount of impacts below the normal pool lake level/ Normal Water Level
Permanent impacts (including all excavation,AleEkfill rip rap, retaining walls, etc.) in square feet:
Sf`12f [' il! Sf� , e"Ilt,c/ ct It
Temporary impacts in square feet:
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 walls, etc.) in square feet:
665
_-21 CA 4;/ 1 c i i- e/!
Temporary impacts (temporary clearing, construction corridor) in square feet:
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):��/, ,– 2,,,,,,
11. Signature /
f el
Owner/Agent's Signature'
Date
'Agents signature is valid only if an authorization letter from the owner is provided.
FORM: SSGP 02-2017
Page 2 of 4

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Version 12/22/2016
lull bond/
Normal Water Level
Shoreline
Plan View
Cross Section View
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lAt Ful{ Pored/ No rr>t ,l W,ate r Levet)
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Please approximately sketch the following information on this plan (provide dimensions for each
item, such as 10 ft x 100ft) *:
1. All proposed vegetation clearing
2. Location of rip rap or fill to be placed above the Full Pond/ Normal Water Level elevation
3. Location of rip rap or fill to be placed below the Full Pond/ Normal Water Level elevation
4. Location of any proposed structures such as buildings, retaining walls, docks, etc.
5. Location of any excavation or dredging below the Full Pond/ Normal Water Level elevation
6. Location of construction access corridors

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Lake
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Side View
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3 ft below fail pond wateri ew-I 4 ft. above, tA pond water level t ft. aioi mal clear.ig
"if r�'tiessa•y
I Existing bank
10 ft. bank a
height Qy2
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Side Vi -MPLL
FORM: SSGP 02-2017 Page 4 of 4

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EXAMPLE AGENT AUTHORIZATION FORM
Parcel 1D:
Lot No. (if applicable) Pian No (if applicable)
Street Address (if applicable)*
�,�aerty ovvne_r.
owner Name (Print): O 5 {�ilQ L` •#'� kYr
ply ow wes Address (if different than the
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The above registered proPeftY owneh " the above prop", ft hereby auttmim
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be t alf and talcs all actions necessary for the motion, processing. issuance and
accgptwwe of this p"rnit, certification or authorization including all standard and special conditions
ii+e N* car* that the above en*mna ion submitted on this jorm aaet msstrue►aantx+aerte
to #W -hese W*W know -
Authorki El Agent Name / Company: oil
AAgent Signature:
Date: