NCC202128_ESC Approval Submitted_20200520

FE9197400
PAX
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EnvironmentaI Water Quality Division
5er�ieeS 336 Fayetteville street • Raleigh, NC 27602
www.wakegov.com
Construction Plan Application for Sedimentation & Erosion Control
LAND DISTURBANCE — INDIVIDUAL LOT (S)
I. PROPERTY INFORMATION
1. Project Name: Lot 100 Wexford
2. Address: 7417 Wexford Woods Lane
3. Wake County Pin 4: 1831384793
5. Zoning District R-40W
6. River Basin: Neuse
4. Jurisdictional Area: Wake County
(Municipal Area or Wake County)
(Neuse/Cape Fear)
7. County Watershed: Horse Creek
(Falls Lake, Jordan Lake, Swift Creek, etc) use hiips://mgps.raleighnc.gov/iMAPS/
8. Waterbody Index 27-17-(0.7)
(use NC Surface Water Classification Map https://ncdenr.maps.arcgis.com/apps/webappviewer/index.html)
9. Total project area in acres: .649
10. Total area to be disturbed in acres: .649
11. Present Land Use (Check): Non-residential X Subdivision Agricultural Forest Vacant
12. Recorded: Book of Maps No. 017754 Page No. 02631
13. Property in Flood Zone: FEMA/Flood Soils (circle) use https://maps.raleighnc.gov/iNIAPS/)
14. Lot Number(s) 100
15. Total Number of Lots 1
II. DOCUMENTS SUBMITTED TO PORTAL:
Copy of this application X Erosion Control Site Plans X (standard plan or custom plan)
Lot Plan _X (Recorded Plat or Plot Plan showing lots)
Checklist S&E Calculations X Proof of Ownership/Consent Letter X
Signed and notarized Financial Responsibility/Ownership Form: X

III. GENERAL INFORMATION
Property Owner (s) (specify the name of the corporation, individual, etc., who owns the property):
Name: Dougher Development Company
Street Address: 3820 Merton Dr. Raleigh NC 27619
Mailing Address: P.O. Box 20428 Raleigh NC 27619
E-Mail Address: [e-mail]
Phone#: [phone] Cell#: ( Fax#:
2. Applicant* (Person to whom all correspondence will be sent):
Name: Zachary Dougher
Firm/other: Dougher Development Company
Street Address: 3820 Merton Dr. Raleigh NC 27619
Mailing Address: PO Box 20428 Raleigh NC 27619
E-Mail Address: [e-mail]
Phone#: [phone] Cell#: Fax#:
Relationship to Owner: vice President
*If not a resident of North Carolina, a North Carolina agent must be designated for the purpose of
receiving correspondences.
IV. APPLIICANT'S CERTIFICATION
PRINT NAME Zachary Dougher
SIGNATURE
V. FEES
Individual Lot Plan Review Fees
S&E .649
Disturbed acres (to hundredth of acre)
Fees prorated
Individual Lot Permit Fees
S&E .649
Disturbed acres (to hundredth of acre)
Fees prorated
Fees — invoiced upon application
DATE 4/22/2020
Y RESPONSIBLE
x $250.00 = $162.25
round to nearest dollar
x $250.00 = $162.25
round to nearest dollar
IF A LOT HAS A STREAM CROSSSING submit DWQ, 404 and/or 401 approval document
*For flood hazard soils or FEMA crossing, Flood Permit is required - apply to Permit Portal for
Flood Study Permit
Note: apply separately for building permit, well and septic through Permit Portal