20190120 Ver 1_00_TIP_R5779_Madison_Cover Sheet_20190128

Corps Submittal Cover Sheet

Please provide the following info:

1. Project Name: TIP R-5779 Extension of SR 1631 (Crossroads Parkway) to SR 1549 (Calvin Edney Road)
2. Name of Property Owner/Applicant: NC DOT__ _
3. Name of Consultant/Agent: __________________
*Agent authorization needs to be attached.
4. Related/Previous Action ID number(s):
5. Site Address: ____N/A_________________ _____
6. Subdivision Name: _________________________
7. City: _Mars Hill ________________________
8. County: _Madison____________________________
9. Lat: _35.820191 Long: _-82.535421_____(Decimal Degrees Please )
10. Quadrangle Name: _Mars Hill___________________
11. Waterway: _____ Big Branch___________
12. Watershed: _ French Broad River_________________
13. Requested Action:
_X_ Nationwide Permit # __23__
__ General Permit # _
_X_ Jurisdictional Determination Request
___ Pre-Application Request

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The following information will be completed by Corps office:

AID: ______________________________

_____ Prepare File Folder _____ Assign number in ORM _______________ Begin Date

Authorization: ____ Section 10 ____ Section 404

Project Description/ Nature of Activity/ Project Purpose:
________________________________________________________________________________________
Site/Waters Name: ________________________________________________________________________
Keywords: ______________________________________________________________________________