20190020 Ver 1_PCN Form_Revised Pages 1&2_20190109

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Office Use Only:
Corps action ID no.
DWQ project no.
Form Version 1.3 Dec 10 2008
Page 1 of 12
PCN Form — Version 1.3 December 10, 2008 Version
Pre -Construction Notification (PCN) Form
A. Applicant Information
1.
Processing
1 a.
Type(s) of approval sought from the
Corps:
®Section 404 Permit El Section 10 Permit
1b.
Specify Nationwide Permit (NWP) number: 18 or General Permit (GP) number:
1c.
Has the NWP or GP number been verified by the Corps?
❑ Yes
® No
1 d.
Type(s) of approval sought from the DWQ (check all that apply):
® 401 Water Quality Certification — Regular ❑ Non -404 Jurisdictional General Permit
❑ 401 Water Quality Certification — Express ❑ Riparian Buffer Authorization
1 e.
Is this notification solely for the record
because written approval is not required?
For the record only for DWQ 401
Certification:
® Yes ❑ No
For the record only for Corps Permit:
❑ Yes ® No
1f.
Is payment into a mitigation bank or in -lieu fee program proposed for mitigation
of impacts? If so, attach the acceptance letter from mitigation bank or in -lieu
fee program.
❑ Yes
® No
1g.
Is the project located in any of NC's twenty coastal counties. If yes, answer 1 h
below.
® Yes
❑ No
1 h.
Is the project located within a NC DCM Area of Environmental Concern (AEC)?
❑ Yes
® No
2.
Project Information
2a.
Name of project:
Loblolly Landing Subdivision
2b.
County:
New Hanover County
2c.
Nearest municipality / town:
Wilmington
2d.
Subdivision name:
Loblolly Landing Subdivision
2e.
NCDOT only, T.I.P. or state
project no:
3.
Owner Information
3a.
Name(s) on Recorded Deed:
John C. Dieffenbauch (Chris Dieffenbauch)
3b.
Deed Book and Page No.
Book: 6041; Page: 395
3c.
Responsible Party (for LLC if
applicable):
3d.
Street address:
529 Moss Tree Drive
3e.
City, state, zip:
Wrightsville Beach, NC 28408
3f.
Telephone no.:
304-376-3959
3g.
Fax no.:
3h.
Email address:
[e-mail]
Page 1 of 12
PCN Form — Version 1.3 December 10, 2008 Version

4.
Applicant Information (if different from owner)
4a.
Applicant is:
❑ Agent ® Other, specify: Owner/Developer
4b.
Name:
Chris Dieffenbauch
4c.
Business name
(if applicable):
Pompano Development Group, LLC
4d.
Street address:
530 Causeway Drive, Suite D1
4e.
City, state, zip:
Wrightsville Beach, NC 28480
4f.
Telephone no.:
910-239-9277
4g.
Fax no.:
4h.
Email address:
[e-mail]
5.
Agent/Consultant Information (if applicable)
5a.
Name:
Troy Beasley
5b.
Business name
(if applicable):
WithersRavenel
5c.
Street address:
219 Station Road, Suite 101
5d.
City, state, zip:
Wilmington, NC 28405
5e.
Telephone no.:
910-256-9277
5f.
Fax no..-
o.:5g.
5g.
Email address:
[e-mail]
Page 2 of 12
PCN Form — Version 1.3 December 10, 2008 Version