NCC223751_FRO Submitted_20221104

PLAN REVIEW/FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
CATAWBA COUNTY CODE OF ORDINANCES, CHAPTER 16 ARTICLE V
SOIL EROSION AND SEDIMENTATION CONTROL
No person may initiate any land -disturbing activity on one or more acres as covered by the Ordinance before this form
and an acceptable erosion and sedimentation control plan have been completed and approved by the Catawba County
Utilities and Engineering Department. (Please type or print, and if question is not applicable, please N/A in the blank)
PART A
1. Job Name IlEstates - 3 Apartments
2. PIN or 911 Address 1371111565918
3. Purpose of development (residential, commercial, industrial, institutional,etc.) Residential Apartments
4. Approximate soil disturbance date October, 2022
5. Total acreage disturbed or uncovered (including off -site borrow and waste areas) 17.32 Ac.
6. Has an erosion and sedimentation control been filed? r yes r No lX- Attached
7. If you have an Erosion Control billing account, would you like this to be billed? [— yes F No
Account Number
PEOPLE
8. Person to contact should erosion and sediment control issues arise during land -disturbing activity
Name (Harry Pilos E-mail address [e-mail]
Telephone [phone] Cell # [828-238-7901 Fax #
9. Landowner(s) of Record (attach accompanied page to list additional owners)
Name Estates Ill, LLC Telephone [phone] Fax # F_
Current Mailing Address
City (Asheville
Current Street Address
Fairview Road, Suite 130
State
800 Fairview Road, Suite 130
City Asheville State NC
10. Deed Book No. 3752 Page No. 11899
Zip 28803
Zip 28803
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 attached sheet):
Name (Estates III, LLC
Current Mailing Address
Fairview Road, Suite 130
E-mail address [e-mail]
City (Asheville State INC Zip �28803

Current Street Address I800 Fairview Road, Suite 130
City Asheville State NC Zip [28803
Telephone [phone] Fax #
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
City I State Zip
Current Street Address
City I State I Zip
Telephone I Fax # I
2. (b) If the financially responsible party is a Partnership or other person engaging in business under 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 I E-mail address
Current Mailing Address
City
State
Current Street Address
City State
Telephone Fax #
Zip
Zip I
The above information is true and correct to the best of my knowledge and belief and was provided by me under oath (This form
rust 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.
Harry Pilos
Type or Print !!�
Signature
Manager
Title of Authority
11-2-2022
Date
1, Melinda S. Keever , a Notary Public of the County of rsuncomDe State of North
Carolina, hereby certify that Harry Pilos
sworn acknowledge 'hij�&,k `ovc form was executed by him.
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Witness my ha notary se�f�yi�s 2nd day of
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appeared personally before me this day and being duly
November A 2022
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My Commission expires
10-27-2023
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