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HomeMy WebLinkAboutNCC231298_FRO Submitted_20230505 co Pitt County y �'�� Planning Department 0 „ =1 �t Development Services Building /o �j5- � 1717 W. 5t" Street co" Greenville, North Carolina 27834-1696 James F.Rhodes,AICP Telephone: (252)902-3250 Director Fax: (252)830-2576 Financial Responsibility/ Ownership Form Soil Erosion and Sedimentation Control Ordinance No person may initiate any land-disturbing activity on one or more contiguous acres as covered by the Act before this form and an acceptable erosion and sedimentation control plan have been completed and approved by the Pitt County Planning Department. (Please type or print and, if question is not applicable, place N/A in the blank.) Part A. 1. Project Name Hobbs Farm Subdivision 2. Location of land-disturbing activity: County Pitt City or Township Ayden , and Highway/Street Juanita Avenue 3. Approximate date land-disturbing activity will be commenced: 10/03/2022 4. Purpose of development(residential, commercial, industrial, etc.): Residential 5. Approximate acreage of land to be disturbed or uncovered: 12 Acres 6. Has an erosion and sedimentation control plan been filed? Yes X No 7. Person to contact should sedimentation control issues arise during land-disturbing-activity: Name Ken Malpass Telephone (252) 756-1780 8. Landowner(s) of Record (Use blank page to list additional owners): Jones & Smith Contractors, LLC Name(s) Name(s) 112 West Firetower Road Current mailing address Street address Winterville NC 28590 City State Zip City State Zip 9. Recorded in Deed Book No. 4113 Page No. 546 Part B. 1. Person(s) or finnn(s) who are financially responsible for this land-disturbing activity (Use the blank page to list additional persons or firms): Jones&Smith Contractors, LLC Name of person(s)or Firm(s) Name(s) 112 West Firetower Road Current mailing address Street Address Winterville NC 28590 City State Zip City State Zip (252) 717-2551 Telephone Telephone 2. (a) If the Financially Responsible Party is a Corporation, give name and street address of the Registered Agent. Name(s) Current mailing address Street Address City State Zip City State Zip Telephone Telephone (b) If the Financially Responsible Party is a Partnership give the name and street address of each General Partner(Use blank page to list additional partners): Name(s) Name(s) Current mailing address Current mailing address City State Zip City State Zip Telephone Telephone 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 9 an individual or his/her attorney-in-fact or if not an individual by an officer, director, partner, or registered agent with authority to execute instruments for the financially responsible person). I agree to provide corrected inform -ion should there be any change in the information provided herein. Kenn h H. Smith Managing Member Ty, or l Title or Authority e..(/ 8/18/2022 ,Signat Date I, GA. l I e,v, c C. �tN(A 9S ) , , a Notary Public of the County of r ( I I State of North Carolina, hereby certify that K YVQ f1. S' 1 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 g+ti day of 4u5c",1 . 20 Z2. t�� 0;• ^,.▪ � C. ® /p> N&;aiy Nam° . 77, ,� My commission expires O(/1q/27. OS NOTARY s PUBLIC `.,,�eoIJ a `\`°0