NCC215274_FRO Submitted_20210920

For TOWF Use Only Application #:
Project Name:
Date Received: Acres:
Date Approved: Fees Paid:
TOWN of
WAKE FOREST
LAND DISTURBING (E&SC)
PERMIT APPLICATION, PLAN CHECKLIST, &
FINANCIALLY RESPONSIBLE OWNER (FRO) FORM
NO PERSON MAY INITIATE ANY LAND -DISTURBING ACTIVITY ON 1/2 ACRE OR MORE BEFORE THESE FORMS, FEES, AND AN
EROSION AND SEDIMENTATION CONTROL PLAN SEALED BY A NORTH CAROLINA REGISTERED PROFESSIONAL ENGINEER OR
LANDSCAPE ARCHITECT HAVE BEEN COMPLETED AND APPROVED BY THE TOWN OF WAKE FOREST. MULTIPLE SINGLE
FAMILY LOTS THAT DISTURB MORE THAN Y2 ACRE ALSO REQUIRE A PERMIT AND SHALL FOLLOW THE STANDARD
PROCEDURES OUTLINED BELOW. SEE THE UNIFIED DEVELOPMENT ORDINANCE FOR ADDITIONAL INFORMATION AND FULL
ORDINANCE REGULATIONS.
NOTE: THE APPLICATION FEE OF $500.00 PER ACRE ROUNDED UP TO THE NEXT ACRE I. E.: 1.1 ACRES = 2 ACRES*
$500 = $1,000) IS DUE AT TIME OF SUBMITTAL. IF FEES ARE NOT SUBMITTED THE PLAN WILL AUTOMATICALLY BE
DISAPPROVED.
DISCLAIMER: TOWN OF WAKE FOREST FEES AND CHARGES ARE SUBJECT TO CHANGE WITHOUT NOTICE.
PLEASE CALL 919-435-9443 TO CONFIRM CURRENT FEES AND CHARGES.
PART A: PROJECT INFORMATION
PROJECT NAME Rosedale Subdivision Phase 2A
1. TAX PIN NUMBER 1860093411, 1860199054
2. ZONING PUD CU RZ-18-13
3. LOCATION/ADDRESS OF TRACT 1916 AVERETTE RD

4. SUBDIVISION N/A
5. DEED BOOK See list
PAG
*PLEASE PROVIDE A COPY OF THE MOST CURRENT DEED
6. PURPOSE OF DEVELOPMENT Single Family Residential
7. TOTAL NUMBER OF UNITS 66
H. PERCENT IMPERVIOUS SURFACE 42.1%
9. TOTAL TRACT ACREAGE: Phase 2A = 17.57 Ac
LOT# N/A
DB 18318 Pg 973
DB 8971 Pg 1540
10. TOTAL ACREAGE DISTURBED (INCLUDING OFF -SITE UTILITIES AND ROADWORK): 16.0 Ac
11. AMOUNT OF FEE ENCLOSED:
ROUNDED UP ACREAGE 16 * $500/ACRE _ $ 8,000.00
CHECK NUMBER
DATE PAID
DISCLAIMER: Town of Wake Forest fees and charges are subject to change without notice. Please call 919-435-
9443 to confirm current fees and charges.
12. PROPERTY OWNER(S) (PROVIDE LIST OF ADDITIONAL PROPERTY OWNERS ON AN ATTACHED SHEET):
NAME Joseph Lassiter E-MAIL [e-mail]
ADDRESS 8311 Bandford Way, Suite 1, Raleigh NC 27615
PHONE [phone]
CELL 919-971-9643
13. PERSON TO CONTACT SHOULD EROSION AND SEDIMENT CONTROL ISSUES ARISE DURING LAND -DISTURBING ACTIVITY:
NAME Joseph Lassiter E-MAIL [e-mail]
ADDRESS 8311 Bandford Way, Suite 1, Raleigh NC 27615
PHONE [phone] CELL 919-971-9643

14. PLANS PREPARED BY Priest, Craven and Associates, Inc.
ADDRESS 3803b Computer Drive, Suite 104, Raleigh NC 27609
EMAIL [e-mail]
PHONE [phone] CELL 919-781-0300
15. DOCUMENTS SUBMITTED (SUBMITTER TO PLACE A CHECK MARK IN THE BOX):
FEES ($500 per acre rounded up, due upon V review)
✓
FINANCIAL RESPONSIBILITY OWNER FORM
✓
COMPLETED PLAN CHECKLIST
✓
PLANS (to be submitted with construction set)
✓
E&SC CALCULATIONS (1 copy)
✓
STORMWATER CALCULATIONS (1 copy)
✓
MAINTENANCE AND OPERATION AGREEMENT
NCDOT Encroachment/Driveway Permit
DWQ 401 Permit
USACOE 404 Permit
NCGO10000 Permit COC
EROSION & SEDIMENT CONTROL SURETY
APPROXIMATE DATE LAND -DISTURBING ACTIVITY WILL COMMENCE: 07/31/2021
With Phase 1
N/A
In review
In review
Provided post TOWF approval
In process
THE SOIL EROSION AND SEDIMENTATION CONTROL PLAN, supporting documents, maps and
computations submitted for the above tract conform to the requirements of all applicable
sections of the Town of Wake Forest Erosion & Sedimentation Control Ordinance outlined in
the UDO.
Project Manager 04/05/2021
SIGNATURE TITLE DATE

PART B. FINANCIALLY RESPONSIBLE OWNER (FRO)/PERSONS INFORMATION
1. PERSON(S) OR FIRMS WHO ARE FINANCIALLY RESPONSIBLE FOR THE LAND -DISTURBING ACTIVITY PROVIDE A
COMPREHENSIVE LIST OF ALL RESPONSIBLE PARTIES ON AN ATTACHED SHEET):
Tryon Investment Partners II, LLC [e-mail]
NAME EMAIL
8311 Bandford Way Suite 1
ADDRESS
Raleigh NC 27615
CITY STATE ZIP CODE
919-971-9643 919-971-9643
PHONE
CELL
2. IF THE FINANCIALLY RESPONSIBLE PARTY IS NOT A RESIDENT OF NORTH CAROLINA, GIVE NAME AND STREET ADDRESS OF
THE DESIGNATED NORTH CAROLINA AGENT:
NAME
ADDRESS
CITY
EMAIL
STATE ZIP CODE
PHONE CELL
IF THE FINANCIALLY RESPONSIBLE PARTY IS A PARTNERSHIP OR OTHER PERSON ENGAGING IN BUSINESS UNDER AN
ASSUMED NAME, ATTACH A COPY OF THE CERTIFICATE OF ASSUMED NAME. IF THE FINANCIALLY
RESPONSIBLE PARTY IS A CORPORATION, GIVE NAME AND STREET ADDRESS OF THE REGISTERED AGENT:
NAME OF REGISTERED AGENT E-MAIL ADDRESS
ADDRESS
CITY STATE ZIP

PHONE
FAX
The above information is true and correct to the best of my knowledge and belief and was
provided by me under oath (This form must be signed by the Financially Responsible Person if an
individual or his attorney -in -fact, or if not an individual, by an officer, director, partner, or
registered agent with the authority to execute instruments for the Financially Responsible
Person). I agree to provide corrected information should there be any change in the information
provided herein.
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SIG TURE
TITLE OR AUTHORITY
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DATE
I, f rcito C-�rc�cv� a Notary Public of the County of
gyp/ o,ILe , State of North Carolina, hereby certify that
—� 05 e—.D 1. �_w s s I fe►-z, appeared personally before me this day and being
duly sworn acknowledged that the above form was executed by him.
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Witness my hand and notarial seal, this day of r; 1 20al
Notary
My commission expires 5-,9-202,3
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