SW7050223_CURRENT PERMIT_20050504

STORMWATER DIVISION CODING SHEET
POST -CONSTRUCTION PERMITS
PERMIT NO.
SW��`J/�IG�3
DOC TYPECURRENT
PERMIT
❑ APPROVED PLANS
❑ HISTORICAL FILE
DOC DATE
,���0�
YYYYMMDD

� '�pF WArERp
�r r
Michael F. Easley, Governor Wa--t`U
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
>
Mr. Robert Eugene Dunn, Sr.
507 Jimmies Creek Road
New Bem, NC 28560 '
Dear Mr. Dunn:
Alan W. Klimek, P.E. Director
Division of Water Quality
DIVISION OF WATER QUALITY
May 4, 2005
Subject: Permit No. SW70050223
Kale Road Maxi Storage
High Density Stormwater Project
Craven County
The Washington Regional Office received a completed Stormwater Application for the subject project
on February 22, 2005. Staff review of the plans and specifications has determined that the project, as
proposed, will comply with the Stormwater Regulations set forth in Title 15A NCAC 2H.1000. We are
forwarding Permit No. SW7050223 dated May 4, 2005 to Robert Eugene Dunn, Sr. for a wet detention pond
to serve the proposed Kale Road Maxi Storage located on Kale Road in Craven County.
This permit shall be effective from the date of issuance until May 4, 2015 and shall be subject to the
conditions and limitations as specified therein. Pease pay special attention to the Operation and Maintenance
requirements in this permit. Failure to establish an adequate system for operation and maintenance of the
stormwater management system will result in future compliance problems.
If any parts, requirements, or limitations contained in this permit are unacceptable, you have the right
to request an adjudicatory hearing upon written request within thirty (30) days following receipt of this permit.
This request must be in the form of a written petition, conforming to Chapter 150E of the North Carolina
General Statutes, and filed with the Office of Administrative Hearings, 6714 Mail Service Center, Raleigh, NC
27699-6714. Unless such demands are made this permit shall be final and binding.
If you have any questions, or need additional information concerning this matter, please contact me
at (252) 948- 3923.
Sincerely,
Roger K. Thorpe
Environmental Engineer
Washington Regional Office
cc: Thomas Engineering
Craven County Inspections
Vashington Regional Office
Central Files
o `
NhCarc
Nallrrn,
North Carolina Division of Water Quality Washington Regional Office Phone [phone] FAX [phone] Customer Service
Internet: h2o.enr.siate.nc.us 943 Washington Square Mall, Washington, NC 27889 1-877-623-6748

I.\
State Stormwater Management Systems
Permit No. SW7050223
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
STATE STORMWATER MANAGEMENT PERMIT
HIGH DENSITY DEVELOPMENT
In accordance with the provisions of Article 21 of Chapter 143, General Statutes of North Carolina as
amended, and other applicable Laws, Rules, and Regulations
PERMISSION IS HEREBY GRANTED TO
Robert Eugene Dunn, Sr.
Craven County
FOR THE
construction, operation and maintenance of stormwater management systems in compliance with the
provisions of 15A NCAC 2H.1000 (hereafter referred to as the "stormwater rules') and the approved
stormwater management plans and specifications and other supporting data as attached and on file with and
approved by the Division of Water Quality and considered a part of this permit for a wet detention pond and
grassed swale to serve the proposed Kale Maxi Storage located on Kale Road in Craven County.
This permit shall be effective from the date of issuance until May 4, 2015 and shall be subject to the following
specified conditions and limitations:
DESIGN STANDARDS
This permit is effective only with respect to the nature and volume of stormwater described in the
application and other supporting data.
2. This stormwater system has been approved for the management of stormwater runoff as described
on page 2 of this permit, the Project Data Sheet.
3. Approved plans and specifications for this project are incorporated by reference and are enforceable
parts of the permit.

DIVISION OF WATER QUALITY
PROJECT DATA
Project Name:
Kale Road Maxi Storage
Permit Number:
SW7050223
Location:
Craven County
Applicant:
Robert Eugene Dunn, Sr.
Mailing Address:
507 Jimmies Creek Road
New Bern, NC 278 60
Application Date:
2/22/2005
Receiving Stream:
UT to Neuse River
Classification of Water Body:
SC - NSW
Total Site Area:
7.4 ac
Total Impervious:
6.1 ac
Wet Pond Depth:
6.0 ft
Required Storage Volume:
21,264 cf
Provided Storage Volume:
21,783 cf
Required Surface Area:
15,292 sf
Provided Surface Area:
15,400 sf
Controlling Orifice:
2 inch @ elevation 20.5 ft

4. No homeowner/lot owner/developer shall be allowed Jo fill in, alter, or pipe any vegetative practices
(such as swales) shown on the approved plans as part of the stormwater management system
without submitting a revision to the permit and receiving approval from the Division.
5. The following items will require a modification to the permit:
a. Any revision to the approved plans, regardless of size
b. Project name change
C. Transfer of ownership
d. Redesign or addition to the approved amount of built -upon area
e. Further subdivision of the project area.
In addition, the Director may determine that other revisions to the project should require a
modification to the permit,
6. The Director may notify the permittee when the permitted site does not meet one or more of the
minimum requirements of the permit. Within the time frame specified in the notice, the permittee
shall submit a written time schedule to the Director for modifying the site to meet minimum
requirements. The permittee shall provide copies of revised plans and certification in writing to the
Director that the changes have been made,
SCHEDULE OF COMPLIANCE
The permittee will comply with the following schedule for construction and maintenance of the
stormwater management system.
a. The stormwater management system shall be constructed in its entirety, vegetated and
operational for its intended use prior to the construction of any built -upon surfaces except
roads.
b. During construction, erosion shall be kept to a minimum and any eroded areas of the system
will be repaired immediately.
2. The facilities must be properly maintained and operated at all times. The approved Operation and
Maintenance Plan must be followed in its entirety and maintenance must occur at the scheduled
intervals.
The permittee shall at all times provide the operation and maintenance necessary to assure the
permitted stormwater system functions at optimum efficiency including, but not limited to:
a. Semiannual scheduled inspections (every 6 months)
b. Sediment removal
C. Mowing and revegetation of side slopes
d. Immediate repair of eroded areas
e. Maintenance of side slopes in accordance with approved plans and specifications
f. Debris removal and unclogging of outlet structure, orifice device and catch basins and
piping.
4. Records of maintenance activities must be kept and made available upon request to authorized
personnel of DWQ. The records will indicate the date, activity, name of person performing the work
and what actions were taken.
This permit shall become voidable unless the facilities are constructed in accordance with the
conditions of this permit, the approved plans and specifications, and other supporting data.
6, Upon completion of construction and prior to operation of this permitted facility, a certification must
be received from an appropriate designer for the system installed certifying that the permitted facility

has been installed in accordance with this permit, the approved plans and specifications, and other
supporting documentation. Mail the Certification to the Washington Regional Office, 943 Washington
Square Mall, Washington, North Carolina, 27889, attention Division of Water Quality.
7. A copy of the approved plans and specifications shall be maintained on file by the Permittee for a
minimum of five years from the date of the completion of construction.
III. GENERAL_ CONDITIONS
This permit is not transferable. In the event there is a desire for the facilities to change ownership, or
there is a name change of the Permittee, a formal permit request must be submitted to the Division
of Water Quality accompanied by an application fee, documentation from the parties involved, and
other supporting materials as may be appropriate. The approval of this request will be considered on
its merits and may or may not be approved.
2. Failure to abide by the conditions and limitations contained in this permit may subject the Permittee
to enforcement action by the Division of Water Quality, in accordance with North Carolina General
Statute 143-215,6(a) to 143-215.6(c).
3. The issuance of this permit does not preclude the Permittee from complying with any and all statutes,
rules, regulations, or ordinances which may be imposed by other government agencies (local, state,
and federal) which have jurisdiction.
4. In the event that the facilities fail to perform satisfactorily, including the creation of nuisance
conditions, the Permittee shall take immediate corrective action, including those as may be required
by this Division, such as the construction of additional or replacement stormwater management
systems.
The permit may be modified, revoked and reissued or terminated for cause. The filing of a request
for a permit modification, revocation and reissuance or termination does not stay any permit
condition.
6. The Permittee, at least six (6) months prior to the expiration of this permit, shall submit in writing a
request for an extension along with appropriate application fee.
Permit issued this the 4 th day of May, 2005.
NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
for Akan W. Klimek, P.E. Director
Division of Water Quality
By Authority of the Environmental Management Commission
Permit Number SW7050223

Kale Road Maxi Storage — Craven County
Stormwater Permit No. SW7050223
Designer's Certification
I as a duly
Registered Professional Engineer in the State of North Carolina, having been authorized to observe
(pedodicallylweeklylfull time)
the construction of the project,
for
(Project)
(Project Owner)
hereby state that to the best of my abilities, due care and diligence was used in the observation of the project
construction such that the construction was observed to be built within substantial compliance and intent of
the approved plans and specifications.
Signature
Registration Number
Date

Permit No.
(to be provided by DWQ)
State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality OWN[
STORMWATER MANAGEMENT PERMIT APPLICATION FOIECIVEID.
WET DETENTION BASIN SUPPLEMENT FEB 2 2 2005
This form may be photocopied for use as an original
DWO Stormwater Management Plan Review: DWQ- ARO
A complete stormwater management plan submittal includes an application form, a wet detention basin
supplement for each basin, design calculations, and plans and specifications showing all basin and outlet
structure details.
I. PROJECT INFORMATION
Project Name:
- <S'L'-'_5 c
Contact Person: -sa An 6; nom AS _ Phone Number: (Z52 ) 49 3'7 - Z'7 Z'7
For projects with multiple basins, specify which basin this worksheet applies to:
elevations
Basin Bottom Elevation ) �. ��_ _ ft.
Permanent Pool Elevation Zo.4;7-o ft.
Temporary Pool Elevation Z"z.00 ft.
(floor of the basin)
(elevation of the orifice)
(elevation of the discharge structure overflow)
areas
Permanent Pool Surface Area 40 O sq. ft. (water surface area at the orifice elevation)
Drainage Area `1, 3 95 0 ac. (on -site and off -site drainage to the basin)
Impervious Area ac. (on -site and off -site drainage to the basin)
volumes
Permanent Pool Volume
G_7, 9 oy
cu. ft.
(combined volume of main basin and forebay)
Temporary Pool Volume
Z 1 ")
cu. ft.
(volume detained above the permanent pool)
Forebay Volume
53
cu. ft.
(approximately 20% of total volume)
Other parameters
SA/DA1
(surface area to drainage area ratio from DWQ table)
Diameter of Orifice
Z
in.
(2 to 5 day temporary pool draw -down required)
Design Rainfall
l
in.
Design TSS Removal z
[�
%
(minimum 85% required)
Form SWU-102 Rev 3.99 Page 1 of 4

E1
Footnotes:
t When using the Division SA/DA tables, the correct SA/DA ratio for permanent pool sizing should be computed based upon the
actual impervious%•and permanent pool depth. Linear interpolation should be employed to determine the correct value for
non-standard table entries.
2 In the 20 coastal counties, the requirement for a vegetative filter may be waived if the wet detention basin is designed to provide
90% TSS removal. The NCDENR BMP manual provides design tables for both 85% TSS removal and 90% TSS removal.
11. i•-AEQUIRED'-ITEMS CHECKLIST
The following checklist outlines design requirements per the Stormwater Best Management Practices Manual
(N.C. Department of Environment, Health and Natural Resources, February 1999) and Administrative Code
Section: 15 A NCAC 2H .1008.
Initial in the space provided to indicate the following design requirements have been met and supporting
documentation is attached. If the applicant has designated an agent in the Stormwater Management Permit
Application Form, the agent may initial below. if a requirement has not been met, attach justification.
'permanent pool depth is between 3 and 6 feet (required minimum of 3 feet).
forebay volume is approximately equal to 20% of the basin volume,
temporary pool controls runoff from the design storm event.
d. The temporary pool draws down in 2 to 5 days.
e. If required, a 30-Foot vegetative filter is provided at the outlet (include non -erosive flow
calculations) I
The basin length to width ratio is greater than 3:1.�/�p !� S
The basin side slopes above the permanent pool are no steeper than 3:1.
A submerged and vegetated perimeter shelf with a slope of 6:1 or less (show detail).
Vegetative cover above the permanent pool elevation.is specified.
A trash rack or similar device is provided for both the overflow and orifice.
A recorded drainage easement is provided for each basin including access to nearest right-
of-way.
If the basin is used for sediment and erosion control; during, c onstru ction, clean out of the
basin is specified prior to use as a wet detention basin.
A mechanism is specified which will drain the basin for maintenance or an emergency.
111. WET DETENTION BASIN OPERATION AND MAINTENANCE -AGREEMENT
The wet detention basin system is defined as the wet detention basin, pretreatment including forebays and the
vegetated filter if one is provided.
This system (check one) 0 does (doe incorporate a vegetated filter at the outlet.
This system {check ogre) 0 does oes not incorporate pretreatment other than a forebay.
Form SWU-102 Rev 3.99 Page 2 of

Maintenance activities shall be performed as follows:
1. After every significant runoff producing rainfall event and at least monthly:
a. Inspect the wet detention basin system for sediment accumulation, erosion, trash accumulation,
vegetated cover, and general condition.
b. Check and clear the orifice of any obstructions such that drawdown of the temporary pool occurs within
2 to 5 days as designed.
2. Repair eroded areas immediately, re -seed as necessary to maintain -good vegetative cover, mow•vegetative
cover to maintain a maximum height of six inches, and remove trash as needed.
3. Inspect and repair the collection system (i.e. catch basins, piping, swales, riprap, etc.) quarterly to maintain
proper functioning.
4. Remove accumulated sediment from the wet detention basin system semi-annually or when depth is
reduced to 75% of the original design depth (see diagram below). Removed sediment shall be disposed of
in an appropriate manner and shall be handled in a manner that will not adversely impact water quality (i.e.
stockpiling near a- wet detention basin or stream, etc.).
The measuring device use&to determine the sediment elevation shall be such that it will give an accurate
depth reading and not readily penetrate into accumulated sediments.
When the permanent pool depth reads Lf.Sy feet in the main pond, the sediment shall be removed.
When the permanent pool depth reads L'Ak:' feet in the forebay, the sediment shall be removed.
BASIN DIAGRAM
(fill in the blanks)
Permanent Pool Elevation 713.5�
Sediment R\Ele
al El. 11.00 75` °
Sediment Removal Elevation ��n.� 75%
Bottomtion� %--------------------------------------------- ------ I
Bottom Elevation _ 4,CO 25%
FOREBAY MAIN POND .
5. Remove cattails and other indigenous wetland plants when they cover 50% of the basin surface. These
plants shall be encouraged to grow along the vegetated shelf and forebay berm.
6. If the basin must be drained for an emergency or to perform maintenance, the flushing of sediment through
the emergency drain shall be minimized to the maximum extent practical.
Form SWU-102 Rev 3.99 Page 3 of

7. All components of the wet detention basin system shall be maintained in good working order. ' A
1 acknowledge and agree by my signature below that I am responsible for the performance of the seven
maintenance procedures listed above. 1 agree to notify DWQ of any problems with the system or prior to any
changes to the system or responsible party.
Print name:
C-4 f%j ry , \-.1 A
Title: C> LA— /_ �p
Address:__ 5C�''J_T �- �r e S 2 Ec Z)P`�.� _i1 u�c�t�. AC._ZBS,(d
Phone:
Signature:
Date:
Note: The legally responsible party should not be a homeowners association unless more than 50% of the lots have been sold and a
resident of the subdivision has been named the president.
I, A -S 1, D . 72�jja t n l�S _ , a Notary Public for the State of Nar+� G4-4d
County of C e u et1u , do hereby certify that ev -f- �.� e �, +J r.
personally appeared before me this 1 f` day of �, and acknowledge the due
execution of the forgoing wet detention basin maintenance requirements. Witness my hand and official seal,
T
r�
9U B�.®�• .
SEAL
t..
My commission expires_____ _
3+
Form SWU-102 Rev 3.99 Page 4 of 4

VV-a d'r
ROY COOPER
G'm•er'nnt'
-"r,,v_
N-
MICHAEL S. REGAN
s0 rerar•y
Energy, Mineral& WILLIAM E. (TOBY) VINSON, .IR.
!n lertm ! t!r error
Land Resources
ENVIRONMENTAL gUAI.iTY August 13, 2018
Magnolia Investors, LLC
Attention: Mr. Michael D. Hawkins, Manager
P.Q. Box 12821
New Bern, NC 28561-2821
Subject: Stormwater Permit Renewal & Ownership Change
Stormwater Management Permit SW7050223
Kale Road Maxi Storage
Craven County
Dear Mr. Hawkins:
A Division of Energy, Mineral, and Land Resources file review has determined that
Stormwater Permit SW7050223 for a stormwater wet detention system serving the Kale
Road Maxi Storage located at 101 Austin Bradley Ln. in New Bern, NC expires on May
4, 2019. Renewal applications are due 180 days prior to expiration. The permit was
originally issued to Robert Eugene Dunn, Sr. A search of the Craven County tax records
shows that the property covered under this permit is now owned by Magnolia Investors,
LLC. North Carolina General Statutes and the Coastal Stormwater rules require that this
property be covered under a stormwater permit.
Please submit a completed permit renewal application along with a $505.00 fee for
permit renewal and an ownership change application with another $505.00 application
fee. Permit application forms for renewal and ownership change can be found on our
website at: hft s://de .nc. ov/about/divisions/ener -mineral-land-resources/ener -
mineral-land-rules/stormwater-program/post-construction.
North Carolina General Statutes and the Coastal Stormwater rules require that this
property be covered under a stormwater permit. Failure to maintain a permit subjects
the owner to assessment of civil penalties.
If you have questions, please feel free to contact me at [phone]. i will be glad to
discuss this by phone or meet with you. I can e-mail an electronic copy of these
application forms to you if you wish. Let me Know by sending an e-mail to
[e-mail].
Sincerely,
Roger K. Thorpe
Environmental Engineer
State. of North Carolina I Environmcntal Quality ! Cnrrgy, Mineral and Land Res(Airces
Washington Regional Office 1 943 Washington Sgoarr Mall { Wasihingtori, Nl, 278139
252 y46 h483

VT
OFFICE USE ONLY
Date Received Fee Paid Permit Number
FEB 2 2 2005 1 A i,+;;t1) SW76.q-oaa
�K a
DWQ-WARD State of North Carolina
5v�
�C Department of Environment and Natural Resources
Division of Water Quality
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
This form may be photocopied for use as an original
I. GENERAL INFORMATION
1. Applicants name (specify the name of the corporation, individual, etc. who owns the project):
Zj-G�e.-4-
i1�3165-
Ak
UNGONAL
2. Print Owner/Signing Official's name and title (person legally responsible for facility and compliance):
S�
3. Mailing Address for person listed in item 2 rabove:
, Sb t�1 i hat IMF i e S C 1Z��3 L > P LJ
City: J State: Zip: 29560
Telephone Number: ( 252 ) G 3 zU.s�
4. Project Name (subdivision, facility, or establishment name - should be consistent with project name on plans,
specifications, letters, o erasion and maintenance agreements. etc.):
5. Location of Project (street address)
City: County:
6. Directions to project (from nearest major intersection):
r *
7. Latitude:�� 0 3, 5�� Longitude: 7 7 D r 'S[) _ of project
8. Contact person who can answer questions about'the project:
Name: ,J � &, 7G M.i�g _ Telephone Number: CZ.4�Z
II. PERMIT INFORMATION:
1. Specify whether project is (check one):y <Ne Renewal Modification
Form SWU-101 Version 3.99 Page I of

2. If this application is being submitted as the result of a renewal or modification to an existing permit, list the •
existing permit number and its issue date (if known)
).
3. Specify the type of project (check one):
Low�Density V High Density Redevelop General Permit Other
*...Additional"Project Requirem nts (check applicable blanks):
_CAMA Major ____Sedimentation/Erosion Control �404/401 Permit _NPDES Stormwater
Information on required state permits can be obtained by contacting the Customer Service Center at
1-877-623-6748.
III. PROJECT INFORMATION
1. In the space provided below, summarize how stormwater will be treated. Also attach_ a detailed narrative
(one to two pages) describing stormwater management for the project .
W e. - CAP 4C2P-1k -A 0.- \ 7-1 C, t­� A
2. Stormwater runoff from this project drains to the - N e tc S e River basin.
3. Total. Project Area: i, 3�j �JC� acres 4. Project Built Upon Area: 03 %
5. How many drainage areas does the project have?�_
6. Complete the following information for each drainage area. If there are more than two drainage areas in the
project, attach an additional sheet with the information for each area provided in the same format as below.
Basin Information
Drainage Area 1
Drainage Area 2
Receiving Stream Name
Receiving Stream Class
/V5 S G
Drainage Area
Existing Impervious* Area
O
Proposed Impervious*Area
(c
% lmpervious* Area (total)
3
Impervious' Surface Area
Drainage Area 1
Drainage Area 2
On -site Buildings
o Z a'avS
On -site Streets
'tS3 S
On -site Parking
On -site Sidewalks
Other on -site
Off -site
Total:
Total:
' Impervious area is defined as the built upon area including, but not 16ited to, buildings, roads, parking areas,
sidewalks, gravel areas. etc.
Form SWU-101 Version 3.99 Page 2 of

7, How was the off -site impervious area listed above derived? Nzk
IV. DEED RESTRICTIONS AND PROTECTIVE COVENANTS
The following italicized deed restrictions and protective covenants are required to be recorded for all
subdivisions, outparcels and future development prior to the sale of any lot. If lot sizes vary significantly, a table
listing each lot number, size and the allowable built -upon area for each lot must be provided as an attachment.
The following covenants are intended to ensure ongoing compliance with state stormwater management permit number
as issued by the Division of Water Quality. These covenants may not be
changed or deleted without the consent of the State.
2. No more than square feet of any lot shall be covered by structures or impervious materials.
Impervious materials include asphalt, gravel, concrete, brick, stone, slate or similar material but do not include wood
decking or the water surface of swimming pools.
3. Swales shall not be filled in, piped, or altered except as necessary to provide driveway crossings.
4. Built -upon area in excess of the permitted amount requires a state stormwater management permit modification prior to
construction.
5. All permitted runofffrom outparcels or future development shall be directed into the permitted stormwater control
system. These connections to the stormwater control system shall be performed in a manner that maintains the integrity
and performance of the system as permitted.
By your signature below, you certify that the recorded deed restrictions and protective covenants for this project
shall include all the applicable items required above, that the covenants will be binding on all parties and persons
claiming under them, that they will run with the land, that the required covenants cannot be changed or deleted
without concurrence from the State, and that they will be recorded prior to the sale of any lot.
V. SUPPLEMENT FORMS
The applicable state stormwater management permit supplement form(s) listed below must be submitted for each
BMP specified for this project. Contact the Stormwater and General Permits Unit at [phone] for the status
and availability of these forms. -
Form SWU-102
Wet Detention Basin Supplement.
Form SWU-103
Infiltration Basin Supplement
Form SWU-104
Low Density Supplement
Form SWU-105
Curb Outlet System Supplement
Form SWU-loft
Off -Site System Supplement
Form SWU-107
Underground Infiltration Trench Supplement
Form SWU-108
Neuse River Basin Supplement
Form SWU-109
Innovative Best Management Practice Supplement
Form SWU-101 Version 3.99 Page 3 of

VI. SUBMITTAL REQUIREMENTS
Only complete application packages will be accepted and reviewed by the Division of Water Quality (DWQ).
A complete package includes all of the items listed below. The complete application package should be
submitted to the appropriate DWQ Regional Office.
Please indicate that you have provided the following required information by initi
next to each item.
• Original and one copy of the Stormwater Management Permit Application Forr
• One copy of the applicable Supplement Form(s) for each BMP
• Permit application processing fee of $420 (payable to NCD! NR)
• Detailed narrative description of stormwater treatment/management
• Two copies of plans and specifications, including:
Development/Project name
Engineer and firm
-Legend
- North arrow
- Scale
- Revision number & date
Mean high water line
Dimensioned property/project boundary
Location map with named streets or NCSR numbers
- Original contours, proposed contours, spot elevations, finished floor elevations
Details of roads, drainage features, collection systems, and stormwater control measures
Wetlands delineated, or'a note on plans that none exist
- Existing drainage (including off -site), drainage easements, pipe sizes, runoff calculations
Drainage areas delineated
Vegetated buffers (where required)
VII. AGENT AUTHORIZATION
If you wish to designate authority to another individual or firm so that they may provide information on your
behalf, please complete this section.
Designated agent (individual or firrn): oMr4S � ti
Mailing Address: U . O `s ( 3 0 R .. %d
City: a /`*-" State: (- Zip: ZBS 3
Phone: { Z S' �) 3 7� Z i Z'7 _ Fax: Z Z 6 3 b— 2 4+4 9
�T4 M F S 7 41+ @ ct a co
VIII. APPLICANT'S CERTIFICATION
I, (print or type name of person listed in General Information, item 2) _ Zo6elj- L� gQr..e �>, ti^,, S-
certify that the information included on this permit application form is, to the bestbf my knowledge, correct and
that the project will be constructed in conformance with the approved plans, that the required deed restrictions
and protective covenants will be recorded, and that the proposed project complies with the requirements of 15A
NCAC 2H .1000,
Signature
t
Form SWU-101 Version 3.99 Page 4 of 4
Date:

THOMAS ENGINEERING, P.A.
NCDE'NR
Customer Job Materials:Storniwatcr Pennit
Kale Road Maxi-Storagc Stonnwatcr Fce
Cif
RECEIVED
FEB 2 2 2005
DWQ-WARD
2/17/2005
5119
420.00
Branch Bank and "rrusl Co Kale Road Maxi-Storagc Stonnwater Fec 420.00