NCC230007_FRO Submitted_20230111

I u. [OWN or ENGINEERING DEPARTMENT
Holly 128 South Main Street - PO Box 8 Holly Springs, NC 27540
S]J1'1E 't [phone] • FAX [phone]
3'40 rilu rAft 0LINA
Application for Construction Drawing Plan Approval, Erosion & Sedimentation Control Plan Approval, NPDES Stormwater
Review, Land Disturbance Permit Issuance, and Sfalement of Ownership and Financial Responsibility:
(Check All That Apply)
❑ Construction Drawing Plan Review ❑ Erosion & Sedimentation ❑ NPDES Stormwater Review
Control Plan Review
1. Project Name, Project ID, and Phase: Peterson Station at Sunset Lake phase;
2. Description of Construction/Land Disturbance:
Mixed Use
3. Landownor(s) of Record: (Use additional pages if necessary and attach to application)
Sunset Gateway LP
Name Name
PO Box 5608
Address Address
Cary, NC 27512
City, State, Zip City, State, Zip
919-468-2639
Telephone Fax Telephone Fax
Mobile Phone Email Address Mobile Phone Email Address
4. Future Landowner(s), if Applicable: (Ilse additional pages if necessary and attach to application)
Name Name
Address Address
City, State, Zip City, State, Zip
Telephone Fax Telephone Fax
Mobile Phone Email Address Mobile Phone Email Address
5. List Book & Page where Deed or Instrument is Filed in Wake County:
Location Description: Sunset Lake and Stephenson Rds
Parcel Identification Number (PIN): 0750721531 Tax Map, Block, and Lot Number: _
Book: 16979 Page: 1010 Book: Page:
6. Person(s) or Firm(s) Financially Responsible for Land -Disturbing Activity
PRIII/DRP Holly Springs Station LP
Name Name
501 Fayetteville St
Address Address
Raleigh, NC 27601
City, State, Zip City, State, Zip
919-582-2044
Telephone
919-522-9703
Mobile Phone
9001
512114
Fax
[e-mail]
Email Address
Telephone
Fax
Mobile Phone Email Address

Application for Construction Drawing Plan Approval, Erosion & Sedimentation Control Plan Approval, NPDFS
Stormwater Review, Land Disturbance Permit Issuance, and Statement of Ownership and Financial Responsibility.
7. Registered Agent, if any, for Person(s) or Firm(s) Financially Responsible:
(NOTE; A North Carolina agent is required if the applicant is not a resident of North Carolina.)
Name
Address
City, State, Zip
Telephone Fax
Mobile Phone
Email Address
8. Plans Prepared By:
The Spaulding Group 919-854-7990
Name of Firm/Person Telephone
5318 Burning Oak Ct
Address
Raleigh, NC 27606
City, State, Zip
SitelProject information:
Total Size of Tract: 19.427
Length of Sidewalk:
Length of Water Line:
Length of Greenway:
# Stormwater BMPs < 5 acres:
Latitude: 35 38 51.89
FEMAIFIRM Map #:
Mobile Phone
[e-mail]
Email Address
Fax
acres Area Disturbed: 18.873 acres ftz
linear feet Length of Streets: linear feet
linear feet Length of Sewer Line: linear feet
Length of Stormwater: linear feet
# Stormwater BMPs > 5 acres:
Longitude: 078 50 43.41
Panel #: Effective Date:
Total Post Development Impervious Surface:
10. Approximate Date Land Disturbance Will Begin:
492,228
Fe
11. Signature and Witneshe above information is true and correct to the best of my knowledge and
belief as provided y m while under oath.
C.\-irl5 Cu--d t)
Signature of Person Financially Responsible Type or Print Name legibly
M er-te� r 21 14 1 zz
Co or Authority I pate
S �-o a Notary Public of the County of ��..
`` �, hereby certify_ .
that . C,�nv� 9 i n n personally before me this day and under oath acknowledged that
this Application for Construction Drawing Plan Approval and Erosion & Sedimentation Control Plan Approval/Land
Disturbance Permit Statement of Ownership and Financial Respon ibility was executed by him or her.
Witness my hand d notar' eal 's tt� day of � A 20 a a.
F'IAvGk (� k t0
Signature of Notary Public My Commission Expires
SEAL `omaGAl-
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ON
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FOR OFFICE USE ONLY
Date Completeness Verified:
Project Number: PN-
Fees Paid:
❑ Construction Drawing Review Fees
❑ Erosion & Sedimentation Control
Plan Review Fees