NCC223663_FRO Submitted_20221108

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Land -Disturbing
Permit Application
Please complete both pages of this form and return to: For Office Use:
Physical Address Mailing Address
80 East St. PO Box 548
Pittsboro, NC 27312 Pittsboro, NC 27312
Phone: [phone]
Please see PERMITTING FLOW CHART to determine which permit and plan requirements apply to
your project and then check one of the boxes below:
Land -Disturbing Permit. The following items are required to obtain this permit: completed
application, plans, deed, and fees. Land -Disturbing Permit applications must include all parcels/
lots on one application with the total amount of disturbance for all parcel/lots. All clearing and
disturbance must be included when calculating disturbed area.
Fee Requirements:
Permit Fee: $250/disturbed acre
Plan Review Fee: $250/disturbed acre
Fees are rounded up to the next whole acre.
Example: 1 acre or less is $500, 1.01-2 acres is $1,000, and 2.01-3 is $1,500.
Plan
Design Plan: submit (1) copy of an erosion control plan completed & sealed by a professional land
surveyor, professional engineer, or registered landscape architect. This plan must meet the criteria of the
Chatham County Erosion Control Plan Review Checklist and include all applicable construction details.
These can be found on the Chatham County Watershed Protection website, on the Erosion Control
webpage. This plan must satisfy all local, state, and federal minimum plan requirements. _
General Plan: submit (1) copy of site plan along with the Chatham County Residential General Plan. Site
plan is not required to be completed by a design professional. The Residential General Plan can be found
on the Chatham County Watershed Protection website on the Residential Construction webpage_ Indicate
Iot drainage pattern(s) on sheet 1 of the Residential General Plan.
0 Residential Lot Permit. The following items are required to obtain this permit: completed
application, site plan, and fee_ PAGE 3 "FINANCIAL RESPONSIBILITY/OWNERSHIP FORM"
not required.
Fee Requirements:
Plan Requirements:
$100 flat fee
Site Plan showing property boundaries. The site plan required by the
Environmental Health or Central Permitting Departments is sufficient.
ALL CHECKS MADE PAYABLE TO CHATHAM COUNTY
Page 1 of 3

Soil Erosion and Sedimentation Control
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C>€ A-r1Cou€v� Permit Application
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PROJECT NAME: HIGHLAND FARMS DATE: 04.20.22
LOCATION OF PROJECT: 514 HIGHLAND ROAD, APEX, NC 27502
PARCEL #• 0--00-5ese4,
TOTAL ACRES OF ALL PROPERTIES TO HAVE DISTURBANCE: 11.12 AC.
(In the case of residential permit, total acres of subdivision phase)
TOTAL DISTURBED ACRES or SQUARE FEET: 2.49 AC. (108,398 SF)
PURPOSE OF ACTIVITY: EROSION CONTROL SUBMITTAL / LOT GRADING
FEE AMOUNT SUBMITTED: $1,000.00
(S250/acre plan review fee, S250/acre land disturbing permit fee)
LANDOWNER(S) OF RECORD (attach page to list additional owners)
Name: SARAH & STEVEN CAWN Phone: SARAH: 919.539.3919 & STEVEN: 919.696.4246
Address: 8100 INVERSTONE LANE E-Mail: SARAH:sg;[e-mail] & STEVENsmcawnQatt.net
RALEIGH, NC 27606 Signature -
FINANCIALLY RESPONSIBLE PARTY ( rplicable only if different from propeMowner)
Name: CRAIG ZEIGLER Phone: [phone]
Address: PO BOX 745 E-Mail: [e-mail]
ROLESVILLE, NC 27571 Signature:
NORTH CAROLINA AGENT (applicable only if owner or financially esponsible party does not reside in
_North Carolina)
Name: N/A Phone: N/A
Address: N/A
ENGINEERISURVEYOR
Company Name: BATEMAN CIVILSURVEY COMPANY
Address: 2524 RELIANCE AVENUE
APEX, NC 27539
Contact Person: TIM GRISSINGER
Phone: [phone]
E-Mail: NIA
Signature:
EROSION CONTROL
Person to contact should erosion & sediment
control issues arise during land -disturbing activity:
Contact Person: CRAIG ZEIGLER
Company Name: ZEIGLER CLASSIC HOMES & RENOVATIONS, INC.
Phone: [phone]
E-Mail: t•[e-mail] E-Mail: [e-mail]
Page 2 of 3

Soil Erosion and Sedimentation Control
Financial Responsibility/Ownership Form
NOT REQUIRED TO BE COMPLETED FOR RESIDENTIAL LOT PERMITS.
PLEASE READ THE FOLLOWING INFORMATION:
1) This section must be signed in the presence of a Notary
2) All Land -Disturbing permits are valid for up to (2) years from the date of issuance. If circumstances warrant, the permit may be
extended for (2) years per the conditions of the Chatham County Soil Erosion and Sedimentation Control Ordinance. Upon written
notice, the Land -Disturbing permit may be revoked for failure to comply with the Ordinance_ If the permit is revoked, all other
permits and approvals are withheld until the property is once again in compliance with Chatham County regulations. Also, upon
written notice, a civil penalty (fine) can be instigated against the property owner and/or additional financially responsible party (if any)
for violations of the Chatham County Soil Erosion and Sedimentation Control Ordinance. This penalty is up to $5000.00 per violation
per day and is assessed daily for every day the property is in violation. Interfering with or hampering an inspection can result in a civil
penalty without written notice.
3) The information provided on this form is true and correct to the best of my knowledge and belief and was provided by me while
under oath.
4) This form must be signed by the property owner if an individual. if owned by a company or corporation, this form must be signed
by an officer, director, partner, attomey-in-fact, or other person with authority to execute instruments for the corporation and
accompanied by a complete Iist of all partners, managing members and registered agents of the company or corporation.
OWNER OF PROPERTY:
Name and Title: SARAH & STEVEN LAWN
Company (if applica ); NIA
Signature:
ADDITIONAL FINANCIALLY RESPONSIBLE PARTY (if any):
Name and Title: CRAIG ZEIGLER, PRESIDENT
Company: ZEIGLER CLASSIC HOMES & RENOVATIONS, INC.
Signature:
NORTH CAROLINA AGENT (if any):
Name and Title: NIA
Company: NIA
Signature:
1, a Notary Public of Vie. kp- County in the state
of A_1L_ do hereby certifythat,S-den rawvk.n =tiK personally
appeared before me this day and under oath acknowledged reading the information above and acknowledged thatthe
above form was executed by him or her.
Witness my hand and official seal, this the l day of %lit , 20�Z -
JAKOB iV# BRON
NOTARY PUBLIC
WAKE COUNTY, NORTH CAROLINA
My COMrmslcfl Expires R'K- ZdZZ
Notary Public
My commission expires Zo Z (SEAL)