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Home My WebLink AboutNCC213459_ESC Approval Submitted_20210614l" WinstonSalem Phone: 336-747-8000 Project Overview David Hickman Brookberry Project Name: David Hickman Brookbery Jurisdiction: City of Winston-Salem ProjectlD: 543237 Financial Responsibility/Ownership Form Project Name: David Hickman Brookbery Project Information City Hall Building 101 N. Main Street, Suite 53 Winston-Salem, NC 27101 Fax 336-748-3173 Additional Location Information: Lots 423, 424, 426, 427, 428, and 429 BrookberyFarm Purpose of Grading: Residential Single Family Subdivision Acreage to be Disturbed: 0.44 Land Owner of Record Property Owner David Hickman Westphalia Construction PO Box 1787 Clemmons, NC 27012 P:336.345.0768 da%Ad@westphaliaconstructon.com Contractor Information Value of Grading Contract: 0 City of W-S Contractor's ID #: Financially Responsible Parties State: NC County: Forsyth l' City of Winston-Salem Stormwater & Wi�sCu�Salcm Erosion Control City of W-S Stormwater & Erosion Control Address(es), Parcel(s), or PIN#(s): • 5896-63-8921 (Unverified) • 5896-63-8960 (Unverified) • 5896-63-8824 (Unverified) • 5896-63-8874 (Unverified) • 5896-73-0706 (Unverified) • 5896-63-9790 (Unverified) Approximate Date to Commence Land -Disturbing Activity: 04/28/2021 Total Acreage: 0.51 Has a project contractor been selected?: No Please choose which Contractor number you will be providing: Contractor's NC License Number: Created with idtPlans Review 5/19/21 David Hickman Brookberry Page 1 of 2 Person(s) or Firm Financially Responsible David Hickman Westphalia Construction PO Box 1787 Clemmons, NC 27012 P:336.345.0768 da%Ad@westphaliaconstructon.com Is the financially responsible party an out-of-state resident?: No Is the financially responsible party part of a partnership?: No Created with idtPlans Review 5/19/21 David Hickman Brookberry Page 2 of 2