NCC215538_FRO Submitted_20211007

GUILFORD COUNTY
GRADING PERMIT APPLICATION
GRADING PERMIT APPLICATION
Please type or print answers: Return to: Earl E. Davis II Inspection
Planning and Development
Post Office Box 3427 Greensboro, NC 27402
[phone] or [phone] (fax)
NAME OF PROJECT: Rogers Farm - Ph. 2 DATE: July 20, 2021
LOCATION OF PROJECT: 568 & 586 Hwy. 62
ACREAGE TO BE DISTURBED: 4.4 Acres ACRES OR ( SQ. FEET)
TOTAL ACREAGE IN TRACT: 70.39 Acres ACRES
IS THIS PROPERTY IN A DESIGNATED WATERSHED? General Watershed
If so, the project must comply with Guilford County Regulations prior to a Grading Permit being issued.
WHAT TYPE OF UTILITIES WILL GO IN DURING CONSTRUCTION? (Water, Sewer, Power, Cablevision,
Telephone, etc.) Storm Sewer, Power, Telephone and Cable TV
ENGINEER/ ARCHITECT/ SURVEYOR: Name: Borum, Wade & Asso. P.A.
Address: 621 Eugene Ct.-Ste. 100 Greensboro, N.C. 27401
Telephone: [phone]
Fax: [phone]
E-Mail: [e-mail]
The Property Owner and additional Financially Responsible Party (if any) do hereby agree to comply with all applicable
Guilford County Regulations pertaining to development if a Grading Permit is issued. The Property Owner and additional
Financially Responsible Party furthermore, do hereby agree to be responsible for the timely installation and maintenance of
erosion control devices throughout the duration of this project. A copy of the Guilford County Development Ordinance is
available from the Guilford County Planning and Development Department.
OWNER OF PROPERTY:
Name: Hunt Road Partners, LLC
Address: 621 Eugene Ct. -Ste. IOU Uso., N.C. 27401
Telephone: (Home) [phone]
(Office)
(Fax)
(E-Mail)
Print Name: iN 17 Q
Signature: AV
ADDITIONAL FINANCIALLY RESPONSIBLE PARTY:
Name: Hunt Road Partners, LLC
Address: 621 Eugene Court -Suite 100
Greensboro. N.C. 27401
Print Name: David B. Michaels, Managing Member
Signature:
Name:
Address:
Telephone:
NORTH CAROLINA AGENT (If applicable)
(Home)
(Office)
(Fax)
(E-Mail)
Telephone: (Home)
(Office)
(Fax)
(E-Mail)
[phone]
[phone]
[e-mail]
No. E2 Grading Permit & Appl. Rev. December 2017 Page 2 of 6

GUILFORD COUNTY
FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
DEPARTMENT OF PLANNING AND DEVELOPMENT
A Grading Permit must be obtained before initiating any land -disturbing activity over one (1) acre (43,560 square feet). A
Grading Permit Application, this Financial Form, a Grading/Erosion Control Plan, a surety, good for one (I) year, and a
permit fee should be submitted 30 days prior to the planned commencement of the land -disturbing activity.
The above information should be submitted to:
Please type or print answers to the following:
Date: July 20, 2021
Name of Project: Rogers Farm - Ph. 2
Location of Project: 568 & 586
Acreage of Land to be Disturbed:
LATITUDE 35.912033
iwy 62
4.4 Acres
Earl E. Davis II - Inspections Division
Guilford County Planning and Development
Post Office Box 3427
Greensboro, N.C. 27402 [phone]
(In Degrees) LONGITUDE-78.764294
Purpose of Activity (street construction, commercial building, parking lot, etc.):
Roadway construction
Landowner(s) of record:
Name: Hunt Road Partners, LLC
Name:
Address: 621 Eugene Ct. -Ste. 100 Address:
Greensboro, N.C. 27401
Telephone: (Home) [phone] Telephone: (Home)
(Office) (Office)
(Fax) (Fax)
(E-Mail) (E-Mail)
Indicate County, Book, and Page where deed or instrument is filed.
Guilford 8480
County Book
(In Degrees)
2755
Page
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. 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, attorney -in -fact, or other person with authority to
execute instruments for the corporation. If the person financially responsible is not a resident of North Carolina, a North
Carolina agent must be designed. If someone other than the owner is financially responsible, their signature is required
below also.
David B. Michaels
Print or Type Name of Individual
Managing Member, Hunt Road Partners, LLC
itle a
igna re
N. C. Agent's Signature (if applicable)
Additional Financially Responsible Party (if applicable)
No. E2 Grading Permit & Appl. Rev. December 2017 Page 3 of 6

PLEASE READ THE FOLLOWING INFORMATION.•
If a Grading Permit is issued it is valid for up to one (1) year from the date it is issued. If circumstances warrant it, it may
be extended for six (6) months after the one (1) year period. Upon written notice the Grading Permit may be revoked for
failure to install devices as shown on the plan in a prompt fashion, or for failure to maintain the devices once they have
been installed. If a Grading Permit is revoked, all other development permits and approvals are withheld until the property
is once again in compliance with Guilford 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 Guilford
County's Soil Erosion and Sedimentation Control Ordinance. This penalty is up to $5000.00 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).
STATE OF r COUNTY OF
OF
I,i N
I, a Notary Public of said County and State, do hereby certify that
I)Hb AL') jj-�, j pl �,� personally appeared before me this day and under oath acknowledged reading the
information above and acknowledged that the above form was executed by him or her.
Witness my hand and official seal, this the 2jj1P1 day of jjtW 12024
Notary Public
My Commission Expires: �```\\�r1pJ�A C 9
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Rockingham
County
(SEAL) My Comm. Exp.
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STATE OF (ADDITIONAL FINANCIALLY RESPONSIBLE PARTY SIGNATURE)
COUNTY OF
I, a Notary Public of said County and State, do hereby certify that
personally appeared before me this day and under oath acknowledged reading the information above and
acknowledged that the above form was executed by him or her.
Witness my hand and official seal, this the day of
My Commission Expires:
Notary Public
(SEAL)
20
No. E2 Grading Permit & Appl. Rev. December 2017 Page 4 of 6