HomeMy WebLinkAboutNCC215670_FRO Submitted_20211014FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
SEDIMENTATION POLLUTION CONTROL ACT
No person may initiate any land -disturbing activity on one or more acres as covered by the Act before this
form and an acceptable erosion and sedimentation control plan have been completed and approved by the
Land Quality Section, N.C. Department of Environment and Natural Resources. (Please type or print and, if
the question is not applicable or the e-mail and/or fax information unavailable, place N/A in the blank.)
Part A.
1. Project Name Sonny Properties Boat and RV Parking
2. Location of land -disturbing activity: County Franklin City or Township
Hicks Rd 36.06183-78.45784
Highway/Street Latitude Longitude
3. Approximate date land -disturbing activity will commence: October 2021
4. Purpose of development (residential, commercial, industrial, institutional, etc.): Residential
5. Total acreage disturbed or uncovered (including off -site borrow and waste areas): 3.86
6. Amount of fee enclosed: $ 260.00 . The application fee of $65.00 per acre (rounded
up to the next acre) is assessed without a ceiling amount (Example: a 9-acre application fee is $585).
7. Has an erosion and sediment control plan been filed? Yes No Enclosed X
Person to contact should erosion and sediment control issues arise during land -disturbing activity:
Name Missy Dodrill E-mail Address Missy@dancoelectrical.com
Telephone 919.562.3191 Cell # n/a Fax # n/a
9. Landowner(s) of Record (attach accompanied page to list additional owners)
Sonny Properties LLC
n/a n/a
Name
Telephone Fax Number
104 Gregory Manor
n/a
Current Mailing Address
Current Street Address
Youngsville NC
27596
n/a n/a n/a
City State
Zip
City State Zip
10. Deed Book No. 1462
Page No.
657-659 Provide a copy of the most current deed.
Part B.
1. Person(s) or firm(s) who are
financially
responsible for the land -disturbing activity (Provide a
comprehensive list of all responsible
parties
on an attached sheet):
Sonny Properties LLC
Missy@dancoelectrical.com
Name
E-mail Address
104 Gregory Manor
Same
Current Mailing Address
Current Street Address
Youngsville NC
27596
City State
Zip
City State Zip
919.562.3191
n/a
Telephone
Fax Number
2. (a) If the Financially Responsible Party is not a resident of North Carolina, give name and street address
of the designated North Carolina Agent:
Name
E-mail Address
Current Mailing Address
Current Street Address
City State
Zip City State Zip
Telephone
Fax Number
(b) 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
Current Mailing Address
Current Street Address
City State
Zip City State Zip
Telephone
Fax Number
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.
Type or print name
Title or Authority
Signature Date
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, a Notary Public of the County of
State of North Carolina, hereby certify that appeared
personally before me this day and being duly sworn acknowledged that the above form was
executed by him.
Witness my hand and notarial seal, this day of 20
Notary
Seal
My commission expires