HomeMy WebLinkAboutSW5210304_Application_20210330DEMLR USE ONLY
Date Received Fee Paid Permit Number
Applicable Rules: ❑ Coastal SW -1995 ❑ Coastal SW - 2008 ❑ Ph II - Post Construction
(select all that apply) ❑ Non -Coastal SW- HQW/ORW Waters ❑ Universal Stormwater Management Plan
❑ Other WO Mcwt Plan:
State of North Carolina
Department of Environment and Natural Resources
Division of Energy, Mineral and Land Resources
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
This form may be photocopied for use as an original
I. GENERAL INFORMATION
1. Project Name (subdivision, facility, or establishment name - should be consistent with project name on plans,
specifications, letters, operation and maintenance agreements, etc.):
Youn sville Storm e
2. Location of Project (street address):
519 N. Hillsboro St.
City!y2mna sville _ _._... w County;Franklu? ._..___ Zip 27596
3. Directions to project (from nearest major intersection):
From the intersection of of W. Main Street and Colle�treet� head north on College Street Route 1148 for
.25 miles veer left at fork in road onto Park Avenue, site is .14 miles from intersectionofPark Avenue and
Hillsboro Street
4. Latitude;36° 01' 53"uNwwwww _ Longitude:-78° 28' 53" W of the main entrance to the project.
II. PERMIT INFORMATION:
1. a. Specify whether project is (check one): ®New ❑Modification ❑ Renewal w/ Modificationt
tRenewals with modifications also requires SWU-102 - Renewal Application Form
b. If this application is being submitted as the result of a modification to an existing permit, list the existing
permit number _ , its issue date (if known)—..,-,, ____ -.N and the status of
construction: ❑Not Started ❑Partially Completed* ❑ Completed* *provide a designer's certification
2. Specify the type of project (check one):
❑Low Density ®High Density ❑Drains to an Offsite Stormwater System ❑Other
3. If this application is being submitted as the result of a previously returned application or a letter from
DEMLR requesting a state stormwater management permit application, list the stormwater project number,
if assigned, ww and the previous name of the project, if different than currently
proposed, ..- .............
4. a. Additional Project Requirements (check applicable blanks; information on required state permits can be
obtained by contacting the Customer Service Center at 1-877-623-6748):
❑CAMA Major ®Sedimentation/Erosion Control: 8 ac of Disturbed Area
❑NPDES Industrial Stormwater ❑404/401 Permit: Proposed Impacts ............__
b.If any of these permits have already been acquired please provide the Project Name, Project/Permit Number,
issue date and the type of each permit:�IT mmITm m
5. Is the project located within 5 miles of a public airport? ®No ❑Yes
If yes, see S.L. 2012-200, Part VI: Jitip'jimab� 0,.0 ,gwai �uu,. �: /vye p,fV�Iu o vgti, pi „ a I i,aw 'o,
Form SWU-101 Version Oct. 31, 2013 Page 1 of 6
III. CONTACT INFORMATION
1. a. Print Applicant / Signing Official's name and title (specifically the developer, property owner, lessee,
designated government official, individual, etc. who owns the„laroject):
Applicant/Organization:C4-Y5LLC
Signing Official & Title:t. Austin„Williams Manager
b. Contact information for person listed in item 1a above:
Street Address:121 W. Trade St Suite 2550 _._.._._....... �._
City:Charolotte State:NC � _ Zip:28202.
Mailing Address (if applicable):
City:. State: zip:--
--- Phone: 70( 4 — 6216430_.._....�.....__ Fax: . ...._._._ ....ww.
Email:awilliams®csere.com
c. Please check the appropriate box. The applicant listed above is:
❑ The property owner (Skip to Contact Information, item 3a)
❑ Lessee* (Attach a copy of the lease agreement and complete Contact Information, item 2a and 2b below)
® Purchaser* (Attach a copy of the pending sales agreement and complete Contact Information, item 2a and
2b below)
❑ Developer* (Complete Contact Information, item 2a and 2b below.)
2. a. Print Property Owner's name and title below, if you are the lessee, purchaser or developer. (This is the
person who owns the property that the project is located on):
Property Owner/Organization:]ames T. Moss Heirs (David B. Mossy lames T. Moss lr.. William T Moss)
Signing Official & Title:David B. Owner
b. Contact information for person listed in item 2a above:
Street Address:3609 Carrigo Drive
i :Ra (ftkm
�.w. tate:N _ Zip:27612
Mailing Address (if applicable):
City:
State:-,,,,,, --- -Zip:
Phone: (919 )215-1430 Fax:
Email:davidbmoss58@msn.com
3. a. (Optional) Print the name and title of another contact such as the project's construction supervisor or other
person who can answer questions about the project:
Other Contact Person/Organization:Ark Consultin,Grou1, PL LC
SigningOfficial & Title:Dan Withers, PE„ Project Mana gel r m
b. Contact information for person listed in item 3a above:
Mailing Address:2755-B Charles Blvd. ....
ty .Green e........................................... NC Zip:27858 �.
i State:
Phone: 252 h „ 565-1017 Fax: (252 y_5655-8839 m
Email:dan.withers@arkconsulti U oul com__
4. Local jurisdiction for building permits: Franklin Countyww
Point of Contact:!-q Inshi ...Sut gndsor Phone #: (919 w w496 2281 x1311
Form SW-101 Version Oct. 31, 2013 Page 2 of 6
III. CONTACT INFORMATION
1. a. Print Applicant / Signing Official's name and title (specifically the developer, property owner, lessee,
designated government official, individual, etc. who owns the project):
Applicant/Organization:C4-YS LLC
Signing Official & Title:]. Austin Williams Manager
b. Contact information for person listed in item 1a above:
Street Address:121 W. Trade.5t., Suitew2550 w ...mm...
City:Charolotte State:NC Zip m28202
Mailing Address (if applicable): __ wwwww www wwwwwwwwwwwwww
City:. State: ... _... Zip:....mm
Phone: t704 ) 621-6430 Fax:
Emajl:awflhams@csere.com
c. Please check the appropriate box. The applicant listed above is:
® The property owner (Skip to Contact Information, item 3a)
❑ Lessee* (Attach a copy of the lease agreement and complete Contact Information, item 2a and 2b below)
® Purchaser* (Attach a copy of the pending sales agreement and complete Contact Information, item 2a and
2b below)
❑ Developer* (Complete Contact Information, item 2a and 2b below.)
2. a. Print Property Owner's name and title below, if you are the lessee, purchaser or developer. (This is the
person who owns the property that the project is located on):
Property Owner/Organization:Cora Underwood Lee
Signing Official & Title:Cora Underwood Lee Property Owner
b. Contact information for person listed in item 2a above:
Street Address:501 Hillsboro Street
City:Youn es� vine
Mailing Address (if applicable):_. lmmmm� mmma?
City
Phone:
Email:_ .. .' • �...
State:NC __ Zip:27596 ___. _.....
State: Zip:
Fax: (�mmm .. _...._......)..._......_�. _w_....ww ._w.......
3. a. (Optional) Print the name and title of another contact such as the project's construction supervisor or other
person who can answer questions about the project:
Other Contact Person/Organization:ArkvConsulting Group, PLLC
Signing Official & Title:Dan Withers,,, PE Protect Manager vwww
b. Contact information for person listed in item 3a above:
Mailing Address:2755-B Charles Blvd. ...............
City:Greenville State:NC Zip:27858
....._ 5658839 Phone: �252 � 5252
..�65-1U17 ._....._....�.._..... Fax: .
Email:dan.withers@arkconsultiAWoul-r_com,�
4. Local jurisdiction on or building permits: Franklin Cuntyom Point of Contact:Tomm r_Harr s ),, Supervisor Phone #: (919 496-2281 x1311
Form SWU-101 Version Oct. 31, 2013 Page 2 of 6
IV. PROJECT INFORMATION
1. In the space provided below, briefly summarize how the stormwater runoff will be treated.
Runoff will be conveyed via sheet flaw, Swale and vived conveyance to three infiltration basins. Limited
runoff, where im )ractical to_collect will bypass the treatment system.
2. a. If claiming vested rights, identify the supporting documents provided and the date they were approved:
❑ Approval of a Site Specific Development Plan or PUD Approval Date:
❑ Valid Building Permit Issued Date .. ...wawa
❑ Other: ..www Date:.
b. If claiming vested rights, identify the regulation(s) the project has been designed in accordance with:
❑ Coastal SW - 1995 ❑ Ph II - Post Construction
3. Stormwater runoff from this project drains to the Tar -Pamlico & Neuse _ River basin.
4. Total Property Area: 8.66 acres 5. Total Coastal Wetlands Area: Ow_Yw acres
6. Total Surface Water Area: 0 acres
7. Total Property Area (4) - Total Coastal Wetlands Area (5) - Total Surface Water Area (6) = Total Project
Area+:8.66 acres
+ Total project area shall be calculated to exclude the following: the normal pool of impounded structures, the area
between the banks of streams and rivers, the area below the Normal High Water (NHKq line or Mean High Water
(MHW) line, and coastal wetlands landward from the NHW (or MHM line. The resultant project area is used to
calculate overall percent built upon area (BUA). Non -coastal wetlands landward of the NHW (or MHW) line may
be included in the total project area.
8. Project percent of impervious area: (Total Impervious Area / Total Project Area) X 100 = 58 „ .............a%
9. How many drainage areas does the project have?4 (For high density, count 1 for each proposed engineered
stormwater BMP. For low density and other projects, use 1 for the whole property area)
10. Complete the following information for each drainage area identified in
Project Information item 9. If there
are more than four drainage areas in the project, attach an additional sheet with the information for each area
provided in the same format as below.
Basin Information Draina . e Area 1 Drainage Area 2
Drains ye e Area 3 FDrainage
Area 4
Receiving Stream Name Richland Creek Richland Creek
Brandy Creek
Richland Creek
Stream Class * QNSW QNSW
B;NSW
QNSW
Stream Index Number * 27-21-(0.5) 27-21-(0.5)
28-29-3-(1)
27-21-(0.5)
Total Drainage Area (sf) 88458 32770
28068
150264
On -site Drainage Area (so 88458 32770
28068
150264
Off -site Drainage Area (so
Proposed Impervious Area (sl) 59105 25352
2135
86626
Im illervious Area** total° 67 77
8
58
Impervious' Surface Area Drains a Area 1 Drainage Area 2
Drainage Area 3
Drainme Area 4
On -site Buildings/Lots (so �35400 16475
On -site Streets (sf)
On -site Parking (sf) 23705 8877
86626
2135
On -site Sidewalks (sf)
Other on -site (so
Future (so
Off -site (sf)
Existing BUA*** (sf) E
Total (sf): 59105 25352
1 86626
2135
* Stream ass an Index Number can be determined at: 6a�P � ; �:��a:r�h ��r,r��.�:� r�� r ..rCE r fir+. 'rP sr r kfcjD,
*� n ,
Im ervious area is defined as the built upon area including but not limited to, buildings, roads, parking areas
sidewe alks, gravel areas, etc.
Form SWU-101 Version Oct. 31, 2013 Page 3 of 6
'Report only that amount of existing B UA that will remain after development. Do not report any existing B UA that
is to be removed and which will be replaced by new B UA.
11. How was the off -site impervious area listed above determined? Provide documentation. Topographic Survey
Prgiects in Union Count : Contact DEMLR Central Office staff to check if the project is located within a Threatened &
Endangered Species watershed that may be subject to more stringent stormwater requirements as per 1 SA NCAC 02B .0600.
V. SUPPLEMENT AND O&M FORMS
The applicable state stormwater management permit supplement and operation and maintenance (O&M) forms
must be submitted for each BMP specified for this project. The latest versions of the forms can be downloaded
from 1.
VI. SUBMITTAL REQUIREMENTS
Only complete application packages will be accepted and reviewed by the Division of Energy, Mineral and
Land Resources (DEMLR). A complete package includes all of the items listed below. A detailed application
instruction sheet and BMP checklists are available from
,; Fye
�„�`..1.'�"��.:�.�iu���rftl:� aJ��,c?. The complete application package should be
submitted to the appropriate DEMLR Office. (Thye appropriate office may be found by locating project on the
p p" ,� r � s � Y �:m ��.�p" 3vyg Z °w�"°m d�'�ww1 1 /. p � � 1:1 ^ .)
interactive online ma at �itl u�:war���� a n�:"...�a �rm� ��.
Please indicate that the followin re aired information have been provided b initiali in the space provided
.__....__.__............ __......
for each item. All origi....__...nal.�...__documents MUST be signed and initialed in blue ink. Download the latest versions
for each submitted application package from �ro a� �" A� �� :u i � u ���g� hu win a �;�� � `1 ���°..M.. "� �'."M..� ..rr �µ� sj, d �,u uupr�! ��o_111111c
i� 'd Is
1. Original and one copy of the Stormwater Management Permit Application Form. ...
2. Original and one copy of the signed and notarized Deed Restrictions & Protective Covenants
Form. (if required as per Part VII below)
3. Original of the applicable Supplement Form(s) (sealed signed and dated) and O&M
agreement(s) for each BMP.
4. Permit application processing fee of $505 payable to NCDENR. (For an Express review, refer to
ht : 'www.envhel ).or pa gs onestol ext)ress.hpnl for information on the Express program
and the associated fees. Contact the appropriate regional office Express Permit Coordinator for
additional information and to schedule the required application meeting.)
5. A detailed narrative (one to two pages) describing the stormwater treatment/ management
6. A USGS map identifying the site location. If the receiving stream is reported as class SA or the
receiving stream drains to class SA waters within 1/2 mile of the site boundary, include the 1/2
mile radius on the map.
7. Sealed, signed and dated calculations (one copy).
S. Two sets of plans folded ITtoIT85"-x.14" (sealed, signed, & dated), including:
a. Development/Project name.
b. Engineer and firm.
c. Location map with named streets and NCSR numbers.
d. Legend.
e. North arrow.
f. Scale.
g. Revision number and dates.
h. Identify all surface waters on the plans by delineating the normal pool elevation of
impounded structures, the banks of streams and rivers, the MHW or NHW line of tidal
waters, and any coastal wetlands landward of the MHW or NHW lines.
• Delineate the vegetated buffer landward from the normal pool elevation of impounded
structures, the banks of streams or rivers, and the MHW (or NHW) of tidal waters.
i. Dimensioned property/ project boundary with bearings & distances.
j. Site Layout with all BUA identified and dimensioned.
k. Existing contours, proposed contours, spot elevations, finished floor elevations.
1. Details of roads, drainage features, collection systems, and stormwater control measures.
m. Wetlands delineated, or a note on the plans that none exist. (Must be delineated by a
qualified person. Provide documentation of qualifications and identify the person who
made the determination on the plans.
n. Existing drainage (including off -site), drainage easements, pipe sizes, runoff calculations.
o. Drainage areas delineated (included in the main set of plans, not as a separate document).
for �I�l
Form SWU-101 Version Oct. 31, 2013 Page 4 of 6
p. Vegetated buffers (where required).
9, Copy of any applicable soils report with the associated SHWT elevations (Please identify so
elevations in addition to depths) as well as a map of the boring locations with the existing
elevations and boring logs. Include an 8.5"x11" copy of the NRCS County Soils map with the
project area clearly delineated. For projects with infiltration BMPs, the report should also
include the soil type, expected infiltration rate, and the method of determining the infiltration rate.
(Infiltration Devices submitted to WiRO: Schedule a site visit for DEMLR to verify the SHWT prior
to submittal, (910) 796-7378.)
10. A copy of the most current property deed. Deed book: Attached. Page No: Attached.
11. For corporations and limited liability corporations (LLC): Provide documentation from the NC _ ry
Secretary of State or other official documentation, which supports the titles and positions held
by the persons listed in Contact Information, item 1a, 2a, and/or 3a per 15A NCAC 21-1.1003(e).
The corporation or LLC must be listed as an active corporation in good standing with the NC
Secretary of State, otherwise the application will be returned.
htt "www.secretar .state.nc.us Corporations CSearchasPx
VII. DEED RESTRICTIONS AND PROTECTIVE COVENANTS
For all subdivisions, outparcels, and future development, the appropriate property restrictions and protective
covenants are required to be recorded prior to the sale of any lot. If lot sizes vary significantly or the proposed
BUA allocations vary, a table listing each lot number, lot size, and the allowable built -upon area must be
provided as an attachment to the completed and notarized deed restriction form. The appropriate deed
restrictions and protective covenants forms can be downloaded from l;, lY l z / s ip f null nx�� �ari�i <, 7i° +Z31g1 aria,` jate-,,;,
fio�-rs d ii� i�.)c w. Download the latest versions for each submittal.
In the instances where the applicant is different than the property owner, it is the responsibility of the property
owner to sign the deed restrictions and protective covenants form while the applicant is responsible for ensuring
that the deed restrictions are recorded.
By the notarized signature(s) below, the permit holder(s) certify that the recorded property restrictions and
protective covenants for this project, if required, shall include all the items required in the permit and listed
on the forms available on the website, 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 NC DEMLR, and that they will be recorded prior to the sale of any lot.
VIII. CONSULTANT INFORMATION AND AUTHORIZATION
Applicant: Complete this section if you wish to designate authority to another individual and/or firm (such as a
consulting engineer and/or firm) so that they may provide information on your behalf for this project (such as
addressing requests for additional information).
Consulting Engineer: Dan W PE _._... ........
Consulting Firm: Ark Consultin Groin, PLLC wwwww
Mailing Address:2755-B Charles Boulevard
City:Greenville ......_......._ State:NC Zip:27858
Phone: 252 __ _ _. 565-1017 Fax:
Email:dan.withers@arkconsultin ,j°ou L)�.com
IX. PROPERTY OWNER AUTHORIZATION (if Contact Information, item 2 has been filled out, complete this
section)
I, (print or type name of person listed in Contact Information, item 2a) Cora Underwood Lee ww _ _ .—, certify that I
own the property identified in this permit application, and thus give permission to (print or type name of person
listed in Contact Information, item 1a) 1. Austin Williams with (print or type name of organization Iisted in
Contact Information, item 1a) g uYS mLLCwwwwww to develop the project as currently proposed. A copy of
the lease agreement or pending property sales contract has been provided with the submittal, which indicates the
party responsible for the operation and maintenance of the stormwater system.
Form SW-101 Version Oct. 31, 2013 Page 5 of 6
As the legal property owner I acknowledge, understand, and agree by my signature below, that if my designated
agent (entity listed in Contact Information, item 1) dissolves their company and/or cancels or defaults on their
lease agreement, or pending sale, responsibility for compliance with the DEMLR Stormwater permit reverts back
to me, the property owner. As the property owner, it is my responsibility to notify DEMLR immediately and
submit a completed Name/Ownership Change Form within 30 days; otherwise I will be operating a stormwater
treatment facility without a valid permit.. I understand that the operation of a stormwater treatment facility
without a valid permit is a violation of NC General Statue 143-215.1 and may result in appropriate enforcement
action including the assessment of civil penalties of up to $25,000 per day, pursuant to NCGS 143-215.6.
Signature:.... .... ,,,, _ __... Date: 3 - [7 -ZLZT
I,�' url h� a Notary Public for the State of /" , County of
WA do hereby certify that ��1�` � �re personally appeared
/'t and acknowldge the due execution of the application for
before me this day of
a stormwater permit. Witness my hand and official seal,
Sl1N J CHOE
Notary Public
Wake Co., Northrth Carolina
1 .2024
My Commission Expires June
X. APPLICANT'S CERTIFICATION
expires 06 , 2 f ri2— il
.........
I, (print or hfpe name of person listed in Contact Information, item 1a) ] Austin Williams
certify that the information included on this permit application form is, to the best of 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 the
applicable stormwater rules under5A NCAC 2H .1000 and any other applicable state stormwater requirements.
Signature:
Date ,° ... Z . _,
I '
I, I UI I [.f91 PP _ !� . / �Lb D/'� a Notary Public for the State of �&4 , County of
do hereby certify that AG1S �i n ��L�i^ `l,"a�wt S personally appeared
before me this 21n6ay of I mb 2DZI , and acknowledge the due execution of the application for
C r
a stormwater permit. Witness my hand and official seal, „- V��'� LC,,(! M�".�`� X__� aorz� --
SEAL
M commission expires_, l/1
Y p `.. . .--�ZS.....__
Form SWU-101 Version Oct. 31, 2013 Page 6 of 6
As the legal property owner I acknowledge, understand, and agree by my signature below, that if my designated
agent (entity listedin ContactInformation, itern't) dissolves their company and/or cancels or defaults on their,
lease agreement-, or pending sale, responsibility for compliance with the DEMLR Stormwater permit reverts back
to me, the property owner..As the property owner, it is my responsibility to notify DEMIR irnirnediately and
subr.rwit a completed Narne/Ownership Change Form within 30 days; otherwise I will be operating a stormwater
treatment facility without a valid permit. I understand that the operation of a stormwater treatment facility
without a valid permit is a violation of NC General Statue 143-215.1 and may resultin appropriate, enforcement
action including the asses!' ie t o 'vil penalties of up to $25,000 per day, pursuant to NCGS 143.-215.6.
Signature:: Date�
... ... ..... .. . .. ..... .. ............................ . ..................... . ...... . .....
_C ii a Notary
Public for the State a"inty of
do hereby certify that ------ persemally appeared
before me thi of b zx , a ()-a I -, . c.-I ( &,I led �en,
---- ay R uou an((I/a -I I d the due execution Of the application for
a stormwater permit. Witness my hand an iffijiftal, ........ "Lle
- ---- -- - --------
S FA 1, No',
M
Z/C
0
KI. /A
Umm
X. APPLICANI"S CERTIFICATION
1, (print or type name of person, listed in Contact Information, item 1a) 1. Austin Williams
. . . . ......
certify that the information included on this perrnit application form is, to the best of my knowledge, correct and
that the project will be constructed in conformance with the approved plans, that the required deed resh.-ictions
and protective covenants will be recorded, and that the proposed project complies with the requirements of the
applicable stormwater rules under 15A NCAC 211 .1000 and any other applicable state stormwater requirements.
U
Date::
- - -------------
I a Notary Public-, for the State of �Azzdj_� County of
L1 4 certify that u s -f in We, I,o
"'J" ) , do hereby cert tr,personally appeared
before me this Z2qday of and acknowledge the due execution of the application for
das'u
a stormwater permit. Witness any hand and official seal, �4__at'p L147 I----------
SEAL
r
My commission expires_ —�-l�_,,.,,2q..,_,2-02,,,.,,
Form SWU-101 Version Oct. 31, 2013 Page 6 of 6
Subject: Youngsville Mini Storage Expansion
Franklin County Tax Parcel Identification Nos: 1853-31-3172
Youngsville, Franklin County, North Carolina
To whom it may concern:
As the owner of an interest in the property identified as Franklin County Parcel Number
1853-31-3172 as referenced in Deed Book 2198, Page 1865, of the Franklin County
Registry, please accept this letter as permission for David B. Moss to act on my behalf in
order to authorize C4-YS, LLC the right to apply for State Stormwater and Sedimentation
and Erosion Control permits in accordance with the executed sales contracts.
Sincerely,
Printed Name
Ti ��p��,e
l�fnW m m.QdX. Oa Notary Public for the State of North Carolina, County of
do hereby certify that W1llUM H M65S personally appeared
before me this day of 2021, and
acknowledged the due execution of the forgoing document. Witness my hand and
official seal.
0, s
r"_
My Commission expires
Subject: Youngsville Mini Storage Expansion
Franklin County Tax Parcel Identification Nos: 1853-31-3172
Youngsville, Franklin County, North Carolina
To whom it may concern:
As the owner of an interest in the property identified as Franklin County Parcel Number
1853-31-3172 as referenced in Deed Book 2198, Page 1865, of the Franklin County
Registry, please accept this letter as permission for David B. Moss to act on my behalf in
order to authorize C4-YS, LLC the right to apply for State Stormwater and Sedimentation
and Erosion Control permits in accordance with the executed sales contracts.
Sinc °ely,
'7"
wS s
�.... SS
....... ._.. �.
Printed Name
Title
I, (�•� {/�%G a Notary Public for the State of North Carolina, County of
do hereby certify thaOMlt!�/(,6S%� (}"+ • personally appeared
before me this wwwww_� (� wwww - day of a, 2021, and
acknowledged the due execution of the forgoing document. Witness my hand and
official seal.
Seal
My Commission expires OF�
Amy L Warren
NOTARY PUBLIC
Wake County, NC
My Commisslon Expires February 2, 2023
Subject: Youngsville Mini Storage Expansion
Franklin County Tax Parcel Identification Nos: 1853-20-8270
Youngsville, Franklin County, North Carolina
To whom it may concern:
As the owner of an interest in the property identified as Franklin County Parcel Number
1853-20-8270 as referenced in Deed Book 2193, Page 1944, of the Franklin County
Registry, please accept this letter as permission for Cora Underwood Lee to act on my
behalf in order to authorize C4-YS, LLC the right to apply for State Stormwater and
Sedimentation and Erosion Control permits in accordance with the executed sales
contracts.
Sincerer,
Printed Name
Title u w m a Notary Public for the State of North Carolina, County of
��-�� ..... do hereby certify that mm.. ..�.��r.. �G
_ personally appeared
before me this day of ../OI�L. 2021, and
acknowledged the due execution of the forgoing document. Witness my hand and
official seal.
My Commission expires,'4� ���� ZQ 2"�
SUN J CHOE
Notary Public
Wake Co., North Carolina
_ 1 2024
My Comm�sio� Expi ires June ml X�mrµW