NCG550576_Application_20200513

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PERMIT NAME
RMIT I
WNERSHIP
PPrrnit Number:
1. Facility Name:��J
ME INFORMATION:
1. This request for a name change is a result of:
.z.a. Change in ownership of property/company
b. Name change only
(ft. Other (please explain):
New owner's name (name to be put on permit):
C
1 Ir)c+hltP i
New owner's or signing official's name and title:
4. Mailing address:s
State: � `
E-mail address
Zip Code:
ROY COOPER
MICIIAEL S. RL'GAN
S. JAY 71MMERMAN
Ayr( rcrr
ANGE FOR
0
(Person legally responsible for permit)
Phone
THIS APPLICATION PACKAGE WILL NOT BE ACCEPTED BY THE DIVISION UNLESS ALL OF THE
APPLICABLE ITEMS LISTED BELOW ARE INCLUDED WITH THE SUBMITTAL.
REQUIRED ITEMS:
1. This completed application form
2. Legal documentation of the transfer of ownership (such as a property deed, articles
incorporation, or sales agreement) of
(see reverse side of this page for signature requirements]
State of Nc�nh Carolina Envircmtu�ntal Quality � Wal�f Rr�r,utceti
I G 17 Mail Sctvice Ccntcr � Ralcibh, NC ?7ti9y-1617
919 807 63(X) 91 9-807-6389 FAX
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Applicant's Certification;
n n
LAIAP ' Co , attest that this application for a
name/ownership change has been reviewed and is accurate and complete to the best of my
knowledge. I understand that if all required parts of this application are not completed and that
if all required supporting information and attachments are not included, this application
package will be returned as incomplete.
Signature:
THE COMPLETED APPLICATION PACKAGE, INCLUDING ALL SUPPQRTtNG
INFORMATION & MATERIALS, SHOULD BE SENT TO THE FOLLOWING ADDDRESS:
NC DEG / DWR I NPDES
1617 Mail Service Center
Raleigh, North Carolina 27699-1617

Brief description for the Index
Mitcholl County
pate � � ��
PIN I `? ! `� 00 ` SI - 41 Z �._..._.---
Taxes PAI thru ,,2�19 _�,___...---
By
NORTH CAROLINA GENERAL WARRANTY DEED
RPPROVED BY TAX ASSESSOR TO BE
REG�R ER OF DE DS OFFICE COUNTY
DATE s' 6 z �' Sk' -
Tax Lot No.
Verified by
by
FYriSe Tax if - / // r �./ �
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05-07=2020 04�' J
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B1�. FtE �13
PG; 245-247
Book and
Parcel Identifier No. 1719-00-51-4123
County on the day of
Mail after recording to Charlie A. Hunt, Jr., Attorne at Law; P.O. Box 509; S ruce Pine, NC 28777
instrument was prepared by Charlie A.
76 acre Jacksontown Road
Jr., Attorney at Law; P.O. Box
Pine, NC 28777
THIS DEED made this �J7� day of (,G(� 2020 ,by and between
VIRGINIA TIPTON HOLLIFIELD, Widow
GRANTEE
AUL DANIEL RUCHES, and wife, PAMELA KATHLEEN
IACIAS
163 Jacksontown Road
pruce Pine, NC 28777
Enter in appropriate block for each party: name, address, and, if appropriate, character of entity, e.q. corporation or
partnership.
The designation Grantor and Grantee as used herein shall include said parties, their heirs, successors, and assigns, and
shall include singular, plural, masculine, feminine or neuter as required by context.
WITNESSETH, that the Grantor, for a valuable consideration paid by the Grantee, the receipt of which is hereby
acknowledged, has and by these presents does grant, bargain, sell and convey unto the Grantee in fee simple, all that
certain tot or parcel of land situated in the City of _ , Grasp Creek Township,
Mitchell County, North Carolina and more particularly described as follows:
Being those lands described in Schedule "A"attached hereto and incorporated herein by reference,
The property hereinabove described was acquired by Grantor by instrument recorded in Book 588, Page 77, Mitchell
County Registry. �~
A map showing the above described property is recorded in Plat Book
�..
TO HAVE AND TQ HQLD the aforesaid lot or parcel of land and all privileges and appurtenances thereto belonging to
fhe Grantee in fee simple.
Md the Cantor covenants with the Grantee, that Grantor is seized of the premises in fee simple, hale the nght to y
Y'Ms same rn fee simple, that title is marketable and free and clear of all encumbrances, and that Grantor rlvtvtt warrsM >trrd
dewbrtd ate ttge agarnst the lawful dolma of aN persons whomsoever except for the exceptions herev�aAes ''Utetl

0
�Or
or,
1Title to the property
joint
IN WITNESS WHEREOF, the Grantor has hereunto set his hand arui seal, ox fi cerpo<a hays try
instrument to be signed in its corporate name by its duly authorized Officers and As seW to be hereursto a by
of its Board of Directors, the day and year first above written.
USE BLACK INK ONLY
(corporate rvame)
gy; �SEALj
ATTEST:
President
Secretary (Corporate Seai)
(SEAL}
NORTH CAROLINA, Mitchell County
I, a NotaryPublic of the County and State aforesaid, certify that Yrginia Tipton Ho etd. V�—Grantor.
_ntor.
personally appeared before me this day and acknowledged the eXecul
instrument. Witness my hand and official stamp or seal, this
� t'Lt
2020 r
My commission expires: 04-17-2021 �r
i of the
day of
Notary Publie
SEAL -STAMP NORTH CAROLINA, County.
I, a Notary Public of the County and State aforesaid, certify that
personally came before me this day and acknowledged that he is Secretary of
Use Black Ink a North Carolina corporation, and that by authority
duly given and as the act of the corporation, the foregoing instrument was signed in its name by
President, sealed with its corporate seal and attested by
as its Secretary.
Witness my hand and official stamp or seal, this day of
My commission expires:
The foregoing Certificates) of
Notary Public
is/are certified to be correct. This instrument and this certificate are duly registered at the date and time and in the Book
and Page shown on first page hereof.
REGISTER OF DEEDS FOR
Deputy/Assistant —Reister of Deeds
g
COUNTY

1
BEGINNING on an iron found, ac _' _ _ , � No. � : _ - _ - � witfi � a �- ^f i.�: ' _ _ _ . <' ., �•�: _ � _ '
minutes east 157.17 feet to a ref
Point in the centerline of N.CS.R _ _ _ _ : _ _ : - _ _ _ - _ _ _ `�,�. i12s"s tilte
and dlsuiw.n :north68dec 7=1%44-_._- _=._ =_ -_=. -_-' _� - - ,es2? ---__ __-• '- -- _-
morth 46 degrees 22 m►r� . _s east 3659 - _ _ _ 4 = _ - - - :es east 3E
degrees 09 minutes east 51.00 feet t- _ _ _ _ _ . -g the c e me
line of Lot 2, north 69 .. = - _ es 43 rr _ - _ - - - - !7 '
an acre and shown as Lot `,_,3onap_.:
Book i at Page 331, Mit& County