20091055 Ver 1_Shoreline Stabilization_20091006

Q9- 1 05 5
JIMMY LEWIS & SONS
GRADING AND SEPTIC TANK SERVICE, INC.
3068 CHUB LAKE ROAD
ROXBORO, N.C. 27574
TEL. NUMBER 336 599-9890 FAX NUMBER 336 599 1806
October 5, 2009
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DENR - WATER QUALITY
WETLOW AND STORMWATER BRANCH
Enclosed please find check and application for Shelia Carden's request for
rip rapping shore line at her residence at Hyco Lake in Person County.
Please forward permit to Jimmy Lewis & Sons, Inc. 3968 Chub Lake Road,
Roxboro, N.C. 27574.
Thank You
Portia Lewis
09'1055
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
botton6wder 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 $240.00
for impacts.of to lake bottom of less than 1 acre and $570.00 for impacts to lake bottom of greater
or equal to 1 acre.
Applications should be sent to:
Division of Water Quality 401 Oversight/Express Review Permitting
1650 Mail Service Center
Raleigh, NC 27699-1650 E&LD
1. Applicant Information
Owner/Applicant Information
Name:
2
Mailing Address:
Telephone Number:..
E-mail Address:

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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:
Company Affiliation:
Mailing Address:
Telephone Number:
E-mail Address:
II. Project Information
Fax Number:
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. 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: L, S ohs Nearest Town: e-
Subdivision name or site address (include phase/lot number):
Directions to site please include road numbers, landmarks, etc. (This is not necessary if an adequate
vicinity map is included): 13 3 :k
lob- G?Qt, ' fl-?? 1 ????S Q?j?

2. Describe the existing land use or condition of the site at the time of this application:
3. Property size (acres): I' q,& , W 4 j
4. Nearest body of water (stream/river/sound/ocean/lak
5. Describe the purpose of the proposed work:
c
4,w 47,242 6r
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6. List the type of equipment to be used to construct the project:
7. Amount of impact (including all excavation, backfill, rip rap, retaining walls, etc.) below the
normal pool lake level in square feet or acres:
.1 S
P
8.a. Amount of impact (including all clearing, back fill, excavation, rip rap, retaining walls, etc.)
above the normal pool lake level and 50 feet land-ward in square feet or acres: 12- e
8.b. Please describe vegetation above the normal pool lake level and 50 feet landward to be im acted
(number of trees for instance): G'it a S S 7 7 7, L
Y"

Applicant/Agent's Signature Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
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Please apPraxirnat* sketch the f+c wtng information on Um' plan
(please provide d1knenslons for each Item, such as 10 ft. x IN ft).
1) AN proposed vegetation ctdaring (provide dimensions) Z', ?trO
2) Location of rip rap or fill to be placed above the Ful>I Pond elevWon
3) Location of rip rap or fill to be placed below the Ft* Road elevation 1*7
The location of my, proposed Mures e h as buildings, retaining k G
walso docks, ete.
6) The location of any excavation or d ridging below the Full P-orid
elevation.
0) l.r,cetian of construction aeces!s corridors.
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