NCC230239_FRO Submitted_20230127

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 pt•int, and if question is not applicable, please N/A in the blank)
PART A
1. Job Name lRedwood Hickory - 12th Avenue SE
2. PIN or 911 Address 372219600176,372219607147
3. Purpose of development (residential, commercial, industrial, institutional,etc,)Residential
4. Approximate soil disturbance date July 1, 2022
S, Total acreage disturbed or uncovered (including off -site borrow and waste areas) F27
6. Has an erosion and sedimentation control been filed? r"1 yes F1 No R Attached
7. If you have an Erosion Control billing account, would you like this to be billed? r'1 yes R No
Account Number 1.
PEOPLE
8. Person to contact should erosion and sediment control issues arise during land -disturbing activity
Nance Michael McClelland I E-mail address MMcClelland@bY Redwood.com
..... ... _ ... ..... . -
Telephone [phone] - ( Cell # Fax #
9. Landowner(s) of Record (attach accompanied page to list additional owners)
Name Redwood Hickory 12th Avenue Soutbe i Telephone [phone] Fax #
Current Mailing Address 7007 East Pleasant Valley Road
City Independence State OH Zip 144131
Current Street Address 17007 East Pleasant Valley Road
........ . _...._..... .. ...
City Independence State 10H Zip 44131
10. Deed Book No. Page No,
PART B
1. Person(s) or firms) Nvho are financially responsible for the land -disturbing activity (Provide a comprehensive list
of all responsible parties on attached sheet):
Name ]Redwood Hickory 12th Avenue Southeast NC P1 LLAI E-mail address [e-mail]
Current Mailing Address 7007 East Pleasant Valley Road
City Independence State OH Zip [44131

Current. Street Address I7007 East Pleasant Valley Road
City Independence State 1OH Zip 44131 --
Telephone [phone] Fax it
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 I E-mail address
Current. Mailing Address
City State I Zip
Current Street Address
City State Zip
Telephone Fax #
2. (b) If the financially responsible party is a Partnership or other person engaging in business under assumed name,
attach a corky of the Certificate of Assumed Name. If the financially responsible party is a Corporation, give name
and street address of the Registered Agent:
Name Redwood Hickory 12th Avenue Southeast NC P1 L€6 E-mail address [e-mail] 1
Current Mailing Address 7007 East Pleasant Valley Road
City Independence State OH Zip 44131
Current Street Address 7007 East Pleasant Valley Road
...... ....
City Independence State OH I Zip F44131
Telephone [phone] Fax #
The above information is tme and correct to (lie 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 (he authority to execute instruments for the financially responsible person). I agree to
provide corrected informatio I ould there be any change in the information provided herein.
Type or Prin ame Title of Authority
Signature , __ Date
CAA 1`
I, (� �i,: j i , a Notary Public of the County of '." (66 - cam. State of N-Mili°
Gnrolinx, hereby certify that J,"y' \ �.<){ pie i appeared persona ly before llle this day and being duly
sworn acknowledge that the above form was executed by him.
Wi(nesa my hand an(
Seal
clay of , 20)U.
f�
Jocelyn b. Musarra
Notary Pubtte, State or t,,o Notary
My Comnrlsston Expires: i A y
Aprll 6, 2026 My Commission expires
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