20051962 Ver 1_Complete File_20041025

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!\lichacl F. Easley, Go\'ernor

William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources

Alan W. Klimek, P.E. Director
Division of Water Quality

Mr. Jose R. Pena
1517 Mount Isle harbor Dr.
Charlotte, NC 28214

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NOY 8 -,Z005

November 2, 2005
DWQ# 05-1962
Catawba County

DENR - WATER QUALlT"Y
WETlANDS NlO STORMWATER BRANCH

Subject: Mt. Isle Harbor SID

Approval of 401 Water Quality Certification and Authorization Certificate per the Catawba River Buffer
Protection Rules (15A NCAC 2B .0243) with Additional Conditions

Dear Mr. Pena:

You have our approval, in accordance with the attached conditions and those listed below, to place fill in
or to otherwise impact approximately 0.007 acre of waters and 0.004 acre of riparian buffer for the purpose of
stabilizing approximately 100 linear feet of shoreline on Mountain Island Lakeas described in your application
received on October 25, 2005. After reviewing your application, we have determined that this project is
covered by Water Quality General Certification Number 3492, which can be viewed on our web site at
http://h20.enr.state.nc.us/ncwetlands. The General Certification allows you to use Regional Permit No.
198200030 once it is issued to you by the U.S. Army Corps of Engineers (USACOE). This letter also serves
as your approved Authorization Certificate for impacts to the protected riparian buffers per 15A NCAC 2B
.0243. Please note that you should get any other federal, state or local permits before proceeding with your
project, including those required by (but not limited to) Sediment and Erosion Control, Non-Discharge, and
Water Supply Watershed regulations.

The above noted Certification will expire when the associated USACOE's 404 permit expires unless
otherwise specified in the General Certification. This approval is only valid for the purpose and design that you
described in your application. If you change your project, you must notify this office in writing, and you may be
required to submit a new application for a new certification. If the property is sold, the new owner must be
given a copy of the Certification and approval letter; and is thereby responsible for complying with all
conditions. This approval, however, should not be construed as authorization to impact any part of the 50-foot
riparian buffer that currently exists on the main stem of the Catawba River under the Catawba River Buffer
Protection Rule (15A NCAC 2B .0243). If the total wetland fill for this project (now or in the future) exceeds
one acre, compensatory mitigation may be required as described in 15A NCAC 2H .0506 (h).

In addition to the requirements of the certification, you must also comply with the following condition:

1. No impacts shall occur in the buffer, including the removal of trees, except along the immediate shoreline.

2. Upon completion of the project, the applicanUresponsible party shall complete and return the enclosed
"Certificate of Completion" form to the Division of Water Quality's 401/Wetlands Unit.

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 (that
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 bindi~ unless
k f h . No[thCarolina
you as or a eanng. ,Na/llrnl/!!

North Carolina Division of Water Quality 610 East Center Ave" Suite 301 Moorcsville, NC 28115
Internet: h2o.enr.state.nc.us
An Equal Opportunity/Affirmative Action Employer- 50% Recycled/10% Post Consumer Paper

Phone [phone]
FA,,'< [phone]

Customer Service
1-877-623.6748

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 Mr. Alan Johnson in the Mooresville Regional Office at 704-663-
1699 or Ms. Cyndi Karoly in the Central Office in Raleigh at 919-733-9721.

Sincerely,

. .(2
l) ((-<rJ..t:Cfl~
for Alan W. Klimek, P.E.

cc: Corps of Engineers Asheville Regulatory Field Office
Wetlands Unit- Ian McMillan
CBC
Central Files

Re: TrackingITardies 11/29/05

Subject: Rc: Tracking/Tardies 11/29/05
From: Alan Johnson <[e-mail]>
Date: Tuc, 29 Nov 2005 10:56:49 -0500
To: Ian McMillan <ian,[e-mail]>

1962,1943,1963, 1961

0638 is issued, 1854 comments on BIMS, 1976 issued
1978 issued
Ian McMillan wrote:

Please advise if there is info I need related to any of these projects or if there
are any mistakes. Also let me know if you have not received any particular project
so I can fax/mail that to you.

* *Mooresville: *
_*__Tracking: __

*05-1961, *Powell T. Seymour, Catawba Co, GP30 10/25/05 12/23/05

*05-1963*, J, Wesley Ward, Catawba Co, GP30 10/26/05 12/24/05

*05-1978*, Shuford Development, Catawba Co, NV139 10/27/05 12/25/05

*05-1960, *City of Shelby - East Side Wastewater Facilities, Cleveland Co, NW12
10/28/05 12/26/05

*05-1943, *John McNelly, Iredell Co, GP30 10/20/05 12/18/05

*05-1976*, G.M. Helms Construction, Lot 1216, Iredell Co, GP30 10/27/05 12/25/05

*05-1945*, Town of pineville - J.D. Hughes Park Renovation, Mecklenburg Co, NW39
10/20/05 12/18/05

*05-1962, *Jose R.* *pena, Mecklenburg Co, GP30 10/25/05 12/23/05

__Tardy: __
*05-0638, Ver. 2*, Bridgewater II for The Summit At Lake Norman - Phase IV,
Catawba Co, Mv33 10/13/05 12/11/05

*05-1854*, Moores Chapel Road & 1-485 Retail Village, Mecklenburg Co, *_IP_* Due
12/08/05

* *

**Asheville *
*__Tracking: __
*05-1977*, Schrader Fill Site, Avery Co, NW39 10/27/05 12/25/05

__Tardy:
None

**Washington * *
__Tracking: _
_*05-1969, *Former Robb's Marina, Beaufort Co, CAMA 10/27/05 12/25/05

*05-1949, *Veron C. Miller, Craven Co, NBR GV 10/25/05 12/23/05

*05-1063, *Mobley's Farm Pond, pitt Co, *_IP_* 10/28/05 12/26/05

_ Tardy:_

*05-1744, *Seymour Johnson Air Force Base - VKAG 00-3005, Wayne Co, *_IP_* Due
12/07/05

1 of3 11/29/2005 10:59 AM

Re: Tracking/Tardies 11/29/05

* *

* *

**Wilmington **
_Tracking:
_*05-2112*, Long Beach Pier, Brunswick Co, CAMA EXP 11/23/05 12/21/05

*05-2072*, Lee's Cut Homeowners and Boatowners Association, New Hanover Co, CAMA
EXP 11/17/05 12/15/05

*05-1937*, Camp Lejeune, Bldg. 670, Onslow Co, NW12 10/18/05 12/16/05

*05-1936*, Camp Lejeune, Berkley Manor Waterline Replacement, Onslow Co, NW12
10/18/05 12/16/05

*05-2073*, Harbor View At Arcadius, New Hanover Co, *_IP_* received PN 10/13/05
and application from DCM 11/16/05 - Cyndi said go with either date. - Ian

_Tardy:_

*05-1878*, Rourk Woods, Brunswick Co, NW12 and NW14 10/10/05 12/08/05

*05-1987*, Harpers Crossroads Stream Mitigation Site, Chatham Co, NW27 10/28/05
12/26/05

* *

* *

**Raleigh **
_Tracking:
_*05-1987*, Harpers Crossroads Stream Mitigation Site, Chatham Co, NW27 10/28/05
12/26/05

*05-1985, *Seagrove's Farm, Wake Co, NW12, NW18, NW39, NBR 10/28/05 12/26/05

_Tardy:_

None

**winston-Salem **
_Tracking: _
*05-1940*, Hager Family, LLC, Wilkes Co, NW39 10/18/05 12/16/05

*05-2078*, Naked Creek Stream Restoration, Wilkes Co, NW27 11/17/05 12/15/05

*05-1935*, City of High Point - Deep River Outfall, Segment 3, Guilford Co, NW12
10/18/05 12/16/05

_Tardy:
_*05-1711*, Burlington-Alamance Regional Airport - Runway 24 Extension, Alamance
Co, *_IP_ * Due 12/02

*05-2029*, Koener Place Stream Restoration, Forsyth Co, NW27 11/02/05 12/01/05

**Fayetteville **
_Tracking:
None

_Tardy:

20f3

11/29/2005 10:59 A11

Triage Check List

Date: 10/28/05

Project Name: Jose R. Pena, Lot 67
DWQ#: 05-1962
County: Mecklenburg

To: Alan Johnson, Mooresville Regional Office

60-day Processing Time: 10/25/05 - 12/23/05

From: Cyndi Karoly Telephone: [phone]

The file attached is being forwarded to you for your evaluation.
Please call if you need assistance.

o Stream length impacted
o Stream detcrmination
Wetland determination and distance to bluc-linc surface waters on USFW topo maps
o Minimization/avoidance issues
o Buffcr Rules (Neuse, Tar-Pamlico, Catawba, Randleman)
o Pond fill
O Mitigation Ratios
Ditching
o Are the stream and or wetland mitigation sites available and viable?
o Check drawings for accuracy
o Is the application consistent with pre-application mcctings?
Cumulative impact concern
o
o
o

Comments: As pcr our discussion regarding revision ofthe triage and dclegation proccsses,
pleasc review the attached file, Note that you are the first reviewer, so this file will need to bc
rcvicwed for administrative as well as tcchnical details. If you elect to place this project on hold,
please ask the applicant to provide your requested information to both thc Central Office in
Raleigh as well as the Asheville Regional Office, As we discussed, this is an cxperimental, interim
procedurc 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
improvc this process, especially so that we can plan for the electronic applications, let mc know.
Thanks!

..... U. tlUJ\. lUUO
CHARLOTTE, NC 28201':'1006
704-382-1567 OR TOLL FREE 1-800-443-5193

APPLICATION FOR PERMIT TO STABILIZE THE SHORELINE IN NORTH
CAROLINA
Please type or print and fill in all blanks. If information is not applicable, so indicate by placing NlA in
blank. PLEASE SUBMIT APPUCATION AND APPROPRIATE DUKE POWER FlUNG FEE, PAYABLE
TO DUKE POWER, TO ABOVE ADDRESS.

I. Applicant Information
A. Name
B. Mailing Address
C. Telephone

Jose ~NRPean M. Kois I N\ V
I
1517 Mount Isle Harbor Dr. - Charlotte, NC 28214

704-392-9907

f~~@~i]W@W

OCT 2 5 2005

DErm. W/\TF!' Olll.! ITY
"I: I L.i"J.;.fJ,[) ~IC;(/.~""ATER CRA/;CH

II. Location of Proposed Project
A. Lake Mountain Island Lake
B. Street Address 1517 Mount Isle Harbor Dr.
C. County Mecklenburg
D. City, Town, Community or Landmark Charlotte
E. Section Lot # 67 Subdivision Mllsle Harbor
F. Directions to property by road Hwy 16 N - Left on Mt Isle Harbor Dr before crossing
Bridge over Mountain Island - Bricl< house approximately 1 mile on right

G. Latitude and longitude for the project site ~d:) 531 set/)) I 35,:J.;1tJ' 2fo /' /'I.
H. Please submit a map showing the coordinates or a detailed map (USGS quad map, city map,
etc.) showing the exact location of the project site. (NOTE: Latitude/longitude coordinates can
be found on internet site, www.mapsonu5.com.Directions:Don.tregister.c1ick "Maps., enter
address, draw map, select "Map Clicking Will...., select "LaULong", click map)

Ill. Description of Project
A. Length of wall 100'
B. Material Mountain Rock
C. Distance from property line/shoreline

Will follow existing shoreline

IV. Intended Use of Project Area
A. Private X
B. Commercial

V. Applicant Signature -;J -iet--' ,}(Q.~ / r ~ { /
/

Date

PLEASE NOTE THE FOLLOWING:

. A COPY OF THE COMPLETE APPUCATION WITH A ROAD MAP SHOWING LOCATION OF THE PROPERTY MUST BE SUBMITTED TO: US
ARMY CORPS OF ENGINEERS, 151 PATTON A VENUE. ROOld 208, ASHEVILLE. HC 28801-5006

. A COPY OF THE 'DUKE POWER APPUCATION FOR PERMIT TO STABIUZE THE SHOREUNE IN NORTH CAROUNA' AND SEVEN (7)
COPIES OF THE COMPLETED 'NC DIVISION OF WATER QUALITY PRE-CONSTRUCTION NOTIFICATION APPLICATION' MUST BE
SUBMITTED WITH THE DIVISION OF WATER QUALITY APPLICATION FEE TO: HC DIVISION OF WA TER QUAUTY, A TTENnON: Cyndl
":on>I1I PARICVlFW AI rn; '.1'1 r.RAATR1=1= AI vn RAI F/I;U Nr. '7fJU puom=- ~19-7.1_1-17RA

401 WATER QUALITY CERTIFICATION APPLICATION

The following is an abbreviated application form for those applying for a 401 Water Quality Certification to
impact FERC (Federal Energy Regulatory Commission) regulated lake shore or bottom under the U.S.
Army Corps of Engineers Permit GP30. This Application cannot be used for wetland or stream impacts.
Please provide seven (7) copies of this application and supporting information as well as a non-
refundable application fee to the Division of Water Quality of $200.00 for impacts to lake bottom of less
than 1 acre and $475.00 for impacts to lake bottom of greater or equal to 1 acre.

APPLICATIONS TO BE SENT TO:
DIVISION OF WATER QUALITY WETLANDS UNIT
1650 MAil SERVICE CENTER
RALEIGH, NC 27699-1650

I. Applicant Information
1. Owner/Applicant InformaJr'l
Name Joso Pl?ti~fean M. Ko;s I N\ l)
Mailing Address 1517 Mount Isle Harbor Dr
Charlotte, NC 28214

Telephone Number 704-392-9907
Fax Number
E-mail Address

2. Agent Information (A signed and dated copy of the Agent Authorization letter must be attached
if the Agent has signatory authority for the owner/applicant.)
Name Chip Bridges

Company Affiliation CBC Custom Shorelines, Inc.

Mailing Address 628 Oakridge Farm Hwy

Mooresville, NC 28115

Telephone Number 704-660-5111
Fax Number
E-mail Address

II. Project Information

Attach a vicinity map c1ear1y 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. You may use the diagram below to
make a hand sketch of your project. Also, see the example below for guidance. Both the vicinity
map and site plan must include a scale and north arrow. The footprints of all buildings. impervious
surfaces, or other facilities must be included.

1. Location

County Mecklenburg

Nearest Town

Charlotte

Subdivision name or site address (include phase/lot number):

Mllsle Harbor

Directions to site - please include road numbers, landmarks, etc. (This is not necessary
if an adequate vicinity map is included): Hwy 16 N - left on Mt Isle Harbor Dr at
Mountain Island lake - Houso on right approximately 1 milo

2. Describe the existing land use or condition of the site at the time of this application:
landscaped lawn with brick houso - buffer on lakesido - existing pier

3. Property size (acres): 0.751
4. Nearest body of water (stream/riverlsoundloceanllake):

Mountain Island

5. Describe the purpose of the proposed work:
rock - To control erosion-

Stabilizo shoreline with mountain

6. Ust the type of equipment to be used to construct the project
By barge with track hoe I ~ L~cl 13obcl~-t

Work will be done

7. Amount of impact (including all excavation, backfill, rip rap, retaining walls, etc.) below
3' x 100'

8. a. Amount of impact (including all clearing, back fill, excavation, rip rap, retaining walls,
etc.) above the nonnal pool lake level and 50 feet land-ward in square feet or acres:
l' . X 100'

b. Please describe vegetation above the nonnal pool lake level and 50 feet land-ward to
be impacted (number of trees for instance): 100' buffer - will not be disturbed - worl<
Will be done by barge - Buffer has been cleaned up - Picture attached

5~Ka;s I GfM ___

Applicant/Agent's Signa~re

Date

(Agent's signature is valid only if an authorization letter from the applicant is provided)

Lake (Full Pond)

Full Pond
Shoreline

. ,)
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Please approximately sketch the following information on this plan (please provide dimensions
for each item, such as 10 ft. x 100 ft.):

1} All proposed vegetation clearing (provide dimensions)
2} Location of rip rap or fill to be placed above tho Full Pond elevation
3} Location of rip rap or fill to be placed below the Full Pond elevation
4} The location of any proposed structures such as buildings, retaining walls, docks, etc.
5) Tho location of any excavation or dredging below the Full Pond elevation.
6) Location of construction access corridors.

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DUKE POVJER DIRECTIONS BY ROAD FORlV1

Lake Use Permit Applicants and Contractors: Ease of locating the proposed project
site can have a big impact on permit processing time. Please complete this form
and return it along with your completed permit application to:

DUKE POVlER
C/O LAIlli llaiANAGEl\iENT - EC 12 Q
P. O. BOX 1006
CH\RLOTTE, NC 28201-1006
1-800-443-5193

Type of Permit
Requested
"Circle":

Applicant's Name:- Jose Pe:mlDean M. Ko:s, M!)
I
Lake Name: Mountain Island

Subdivision Name: Mt. Isle Harbor

Property Section:

Lot (s): 67

Private Facili
Commercial Facility
Excavation
Stabilization
Conveyance
Miscellaneous Uses

City: Charlotte County: Mecklenburg
State: NC Zip: _28214
Telephone: [phone]

Directions (from major road or highway): Hwy 16 N- Left on Mt. Isle Harbor Dr.
before crossing bridge at Mountain Island Lake - Brick house on right
approximately 1 mile

Descriptive StrUcture (s) on Property (i.e. brick garage. white fence. mobile home.
etc.

1517 Mount Isle Harbor Dr - Brick home

"'Note: Please use the back of this form, ifdesired, to draw us a map to the site.

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Address City

11517 Mt Isle Harbor D: jCharlotte

Zip
128214

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Find Map I ~\;]p & Directions FAQ

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Charlotte, NC 28214

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Address
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ICharlotte

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Use this map or these directions at your own risk. No representation or warranty is made as to their accuracy, completeness or drivabil
Switchboard will notba responsible for any damages, losses or delays which result from using these directions. Obey alllraffic I

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CHARLOTTE, NC 28201':'1006
704-382-1567 OR TOLL FREE 1-800-443-5193

APPLICATION FOR PERMIT TO STABILIZE THE SHORELINE IN NORTH
CAROLINA
Please type or print and fill in all blanks. If information is not applicable, so indicate by placing NJA in
blank. PLEASE SUBMIT APPUCATION AND APPROPRIATE DUKE POWER FlUNG FEE, PAYABLE
TO DUKE POWER, TO ABOVE ADDRESS. ~ @@@ llW@ ~

I. Applicant Infonnation l!!J
A. Name Jose Petl"pean M. Kois , N\ V 0 C T 2 5 2005
I
1517 Mount Isle Harbor Dr. - Charlotte, NC 2821 OENR - WATER QUALI
704-392-9907 BRANCH

B.
C.

Mailing Address
Telephone

II. Location of Proposed Project
A. Lake Mountain Island Lake
B. Street Address 1517 Mount Isle Harbor Dr.
C. County Mecklenburg
D. City, Town, Community or Landmark Charlotte
E. Section Lot # 67 Subdivision Mt Isle Harbor
F. Directions to property by road Hwy 16 N - Left on Mt Isle Harbor Dr before crossing
Bridge over Mountain Island - Brick house approximately 1 mile on right

G. Latitude and longitude for the project site ~OP 5~' S'l" w I 3S,:),;}tJ' 2"" Ii

H. Please submit a map showing the coordinates or a detailed map (USGS quad map, city map,
etc.) showing the exact location of the project site. (NOTE: Latitudellongitude coordinates can
be found on internet site, www.mapsonus.com.Directions:Don.tregister.c1ick -Maps., enter
address, draw map, select "Map Clicking Will...", select "LatlLong", click map)

III. Description of Project
A. Length of wall 100'
B. Material Mountain Rock
C. Distance from property line/shoreline

Will follow existing shoreline

IV. Intended Use of Project Area
A. Private X
B. Commercial

V. ApPllcantSignature.;J.t ~ j(Q~ / cASt.J
/

Date

PLEASE NOTE THE FOLLOWING:

. A COPY OF THE COMPLETE APPLICATION WITH A ROAD MAP SHOWING LOCATION OF THE PROPERTY MUST BE SUBMITTED TO: US
ARJIYCORPS OF ENGINEERS. 151 PAITON AVENUE. ROOM 208, ASHEVILLE. NC 28801-5006

. A COPY OF THE "DUKE POWER APPLICATION FOR PERMIT TO STABILIZE THE SHORELINE IN NORTH CAROLINA" AND SEVEN (7)
COPIES OF THE COMPLETED "NC DIVISION OF WATER QUALITY PRE-CONSTRUCTION NOTIFICATION APPLICATION" MUST BE
SUBMITTED WITH THE DIVISION OF WATER QUALITY APPLICATION FEE TO: NC DIVISION OF WATER QUALITY, ATTENTION: Cyndl
KlWnltI PARKVU=W AI na :J;17f r.RAATR1=F AI \In RAI F<<;U Nt': nRIW PU/lNF. M~7.U.f7RB

401 WATER QUALITY CERTIFICATION APPLICATION

The following is an abbreviated application fonn for those applying for a 401 Water Quality Certification to
impact FERC (Federal Energy Regulatory Commission) regulated lake shore or bottom under the U.S.
Army Corps of Engineers Penn it GP30. This Application cannot be used for wetland or stream impacts.
Please provide seven (7) copies of this application and supporting infonnation as well as a non-
refundable application fee to the Division of Water Quality of $200.00 for impacts to lake bottom of less
than 1 acre and $475.00 for impacts to lake bottom of greater or equal to 1 acre.

APPLICATIONS TO BE SENT TO:
DIVISION OF WATER QUALITY WETLANDS UNIT
1650 MAIL SERVICE CENTER
RALEIGH, NC 27699-1650

I. Applicant Information
1. Owner/Applicant InfonnCidr'l
Name Jose p{2fi~fean M. Ko;s I N\ I)
Mailing Address 1517 Mount Isle Harbor Dr
Charlotte, NC 28214

Telephone Number 704-392-9907
Fax Number
E-mail Address

2. Agent Infonnation (A signed and dated copy of the Agent Authorization letter must be attached
if the Agent has signatory authority for the owner/applicant.)
Name Chip Bridges

Company Affiliation CBC Custom Shorelines, Inc.

Mailing Address 628 Oakridge Farm Hwy

Mooresville, NC 28115

Telephone Number 704-660-5111
Fax Number
E-mail Address

II. Project Information

Attach a vicinity map cleany 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. You may use the diagram below to
make a hand sketch of your project. Also, see the example below for guidance. Both the vicinity
map and site plan must include a scale and north arrow. The footprints of all buildings, impervious
surfaces, or other facilities must be included.

1. Location

County Mecldenburg

Nearest Town

Charlotte

Subdivision name or site address (include phase/lot number):

Mllsle Harbor

Directions to site - please include road numbers, landmarks, etc. (This is not necessary
if an adequate vicinity map is included): Hwy 16 N - Left on Mt Isle Harbor Dr at
Mountain Island Lake - House on right approximately 1 milo

2. Describe the existing land use or condition of the site at the time of this application:
Landscaped lawn with brick houso - buffer on lakeside - existing pier

3. Property size (acres): 0.751
4. Nearest body of water (stream/riverlsoundloceanllake):

Mountain Island

5. Describe the purpose of the proposed work:
rock - To control erosion-

Stabilizo shoreline with mountain

6. Ust the type of equipment to be used to construct the project
By barge with track hoe / ~ LArle\ 1306c,~+

Worl( will bo done

7. Amount of impact (including all excavation, backfill, rip rap, retaining walls, etc.) below
3' x 100'

8. a. Amount of impact (including all clearing, back fill, excavation, rip rap, retaining walls,
etc.) above the nonnal pool lake level and 50 feet land-ward in square feet or acres:
l' X 100'

b. Please describe vegetation above the nonnal pool lake level and 50 feet land-ward to
be impacted (number of trees for instance): 100' buffer - will not be disturbed - worl(
Will be done by barge - Buffer has been cleaned up - Picture attached

:5u-Ko;s I LAM___

Applicant/Agent's Signat&rc

Date

(Agenfs signaturo is valid only if an authorization leUer from the applicant is provided)

Lake (Full Pond)

Full Pond
Shoreline

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Please approximately sketch the following infonnation on this plan (please provide dimensions
for each item, such as 10 ft. x 100 ft.):

1) All proposed vegetation clearing (provide dimensions)
2) Location of rip rap or fill to be placed above tho Full Pond elevation
3) Location of rip rap or fill to be placed below the Full Pond elevation
4) The location of any proposed structures such as buildings, retaining walls, docks, etc.
5) The location of any excavation or dredging below the Full Pond elevation.
6) Location of construction access corridors.

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Address City
11517 Mt Isle Harbor D. !Charlotte

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[NC

Zip
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DUKE POVJER DIRECTIONS BY ROAD FORM

Lake Use Permit Applicants and Contractors: Ease of locating the proposed project
site can have a big impact on permit processing time. Please complete this form
and return it along with your completed permit application to:

DUKE POWER
C/O LAlm IVIAI'lAGEf.IENT - EC 12 Q
P. O. BOX 1006
CH\RLOTTE, NC 28201-1006
1-800-443-5193

Type of Permit
Requested
"Circle":

Applicant's Name:- Jose Pennhean M. Ko;s,N\!)
I
Lake Name: Mountain Island

Subdivision Name: Mt. Isle Harbor

Private Facili
Commercial Facility
Excavation

Property Section:

Lot (s): 67

Stabilization
Conveyance
Miscellaneous Uses

City: Charlotte County: Mecklenburg
State: NC Zip: _28214
Telephone: [phone]

Directions (from major road or highway): Hwy 16 N- Left on Mt. Isle Harbor Dr.
before crossing bridge at Mountain Island Lake - Brick house on right
approximately 1 mile

Descriptive Structure (s) on Property (i.e. brick garage. white fence, mobile home,
etc.

1517 Mount Isle Harbor Dr - Brick home

"Note: Please use the back of this form, ifdesired, to draw us a map to the site.

DUKE POWER DIRECTIONS BY ROAD FORlVl

Lake Use Permit Applicants and Contractors: Ease oflocating the proposed project
site can have a big impact on permit processing time. Please complete this form
and return it along with your completed permit application to:

DUKE POWER
C/O LAKE MANAGEMENT - EC 12 Q
P. O. BOX 1006
CH \RLOTTE, NC 28201-1006
1-800-443-5193

Type of Permit
Requested
"Circle":

Applicant's Name:- Jose PCi"4/lbean M. KO;S,Mj)
I
Lake Name: Mountain Island

Subdivision Name: Mt. Isle Harbor

Private Facili
Commercial Facility
Excavation

Property Section:

Lot (s): 67

Stabilization

City: Charlotte County: Mecklenburg
State: NC Zip: _28214
Telephone: [phone]

Conveyance
Miscellaneous Uses

Directions (from major road or highway): Hwy 16 N- Left on Mt. Isle Harbor Dr.
before crossing bridge at Mountain Island Lake - Brick house on right
approximately 1 mile

Descriptive StrUcture (s) on Property (i.e. brick garage. white fence. mobile home.
etc.

1517 Mount Isle Harbor Dr - Brick home

t.Note: Please use the back of this form, ifdesired, to draw us a map to the site.

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i.kdiiy '(our Semel1
Address City
11517 Mt Isle Harbor D: ICharlotte

Zip
128214

51310

[NC

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1517 Mt Isle Harbor Dr
Charlotte, NC 28214

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Address
11517 Mt Isle Harbor Dr

State Zip
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City
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Get Directions

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