NCC223671_FRO Submitted_20221026

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: PHASE 4 THE FARM AT CEDAR HOLLOW DATE: July 19, 2022
LOCATION OF PROJECT: 8262 CEDAR HOLLOW ROAD
ACREAGE TO BE DISTURBED: 4.5± ACRES OR (SO. FEET)
TOTAL ACREAGE IN TRACT: 42.78 ACRES
IS THIS PROPERTY IN A DESIGNATED WATERSHED? NO
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.) Power, Cablevision, Telephone, Drain Field Supply Lines, etc.
ENGINEER/ ARCHITECT/ SURVEYOR: Name: Hugh Creed Associates, Inc., PA
Address: 1306 W. Wendover Ave., Greensboro, NC 27408
Telephone: [phone]
Fax:
E-Mail: heaCa_huahereedassociates.com
The Properly 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:
Address:
Telephone: (Home)
(Office
(Fax)
(E-Mail)
The Farm at Cedar Hollow, LLC Name:
PO Box 31125, Charlotte, NC 28231 Address:
336-339-3090
[e-mail]
Print Name: Robert Jessup. Jr.. Member/Manager
Signature:
ADDITIONAL FINANCIALLY RESPONSIBLE PARTY:
Name:
Address:
Print Name:
Signature:
NORTH CAROLINA AGENT (If applicable)
Telephone: (Home)
(Office)
(Fax)
(E-Mail)
Telephone: (Home)
(Office)
(Fax)
(E-Mail)
No. E2 Grading Permit & Appl. Rev. December 2010 Page 2 of 6

GUnYORD COUNTY
FINANCIAL RESP0NSIBILrryJ0ViINERSHIP 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 GradinglErosion Control Plan, a surety, good for one (1) year, and a
permit fee should be submitted 30 days prier 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 19, 2022
Name of Project: Phase 4 — The Farm at Cedar Hollow
Earl E. Davis H - Inspections Division
Guilford County Planning and Development
Post Office Box 3427
Greensboro, N.C. 27402 [phone]
Location of Project: 8262 Cedar Hollow Road
Acreage of Land to be Disturbed: 4.5 + Acres
LATITUDE 360-13'-50" (In Degrees) LONGITUDE-790-48'-30" (in Degrees)
Purpose of Activity (street construction, commercial building, parking lot, etc.): Sinele Family Residential
Landowner(s) of record:
Name: The Farm at Cedar Hollow, LLC
Address: 8262 Cedar Hollow Road
Greensboro, NC
Telephone: (Cell) 336-339-3090
(Office)
(Fax)
(E-Mail) [e-mail]
Indicate County, Book, and Page where deed or instrument is filed
_Guilford 7$50
County Book
Additional Financially Responsible Party
Name:
Address:
Telephone: (Cell )
(Office)
(Fax)
(E-Mail)
1658
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 si ng_ ed 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.
Robert Jessup. Jr.
Print or Type Name of Individual
Member/Manager. The Farm at Cedar Hollow. LLC
Title and Name of Company
i)wner's Signature
N. C. Agent's Signature (if applicable)
Additional Financially Responsible Party (if applicable)
No. E2 Grading Permit & Appl. Rev. December 2010 Page 3 of 6

PLEASE READ THE F'OLLOW17VG AFORMATL011-
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 North Carolina
COUNTY OF Guilford
V395
'M
1, a Notary Public of said County and State, do hereby certify that Robert Jessup. Jr. 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 19th day of July 2022,
My Commission Expires:
August 17, 2025
STATE OF
COUNTY OF
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TY
1, 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)
No. E2 Grading Permit & Appl. Rev. December 2010 Page 4 of 6