HomeMy WebLinkAboutNCC215734_FRO Submitted_20211019NUS
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PLAN Ill 1- I I ��- I: INANCI AL USPO S)131L1TY/OWN lei SHI P FORM
CATAW IAA Cci U "I' Y CODE OF ORMNA NOES, C HA PIER 16 ARTI CLE V
SOIL EROSION AND SMIMENTATION CONTROL
No peaty M.. may Ifiiriat-0 ADY Im l•alieturbing Wrivlc� oer ona or more aaro m rmcred by ttic Oddirance btfbm t'hia fflrm
Lind ark *er_.�MiNe-DrMiOo ana KcdimcIsmrjun ruurlul plan harc bcoe camphoLed curd mj�,prerVedbY Chd (-'Wawhu C mmtY
L'1 i f i L•nginar41n8 Duparrmrnt. (Pl{L+--%e +17:m- or iyr iml- rr-ad if quertiur+ is myt upp�ic'able, rd+V.Ltixr N/,4 i0p tjie bjaq k)
FA R1' A
1. Job Name jjj&gLw WdfidwMa Clearing MWn
'. P I?q tlr 93 1 A d1 ms� i Pin Numbor: 3712115096D
3. 11urpewe cfAaweTopmem I ressticnli-1k CIDmmcn:a,'1I, indusiriu1, inslitullouD8 4L Inr1u11t12A
•I. Appywc1mat-o a+ui I dis turbatkv 410M INny- 2d2l
5. TotaI ncrengr disLrlfbrA liir umoQVerad (ineIoding {rf-YLie b45rro-w L11d wM-Lr 4ktea S) 3JD
6L Ras Lin ergim*n and ;�imim;9iirm control been 10L QQd? r Yes r— No Oz Au ched
7. If yo1L ti.i W a n F:mOn n Con I m I bi I ling 4CELOUILL. would }'m I i ke thi s 10 be 1xiiled? r YC5 79 Ncl
ACxmunt Numbrr
PEOPLE
S. Fcracon to q;mLmm mould ffQnorL and scdimmr cumml im9l; arL� daring land-dL%TurhgnU a tiaitg
Name 5" L{irlgL Jr. E-mail address s&nk�ngJr@grn6rC11.
Valcphrprtr-g2&403.5-56 Fell V ��9-"R3-5588 Fax #
0, T..a,7d0Wf1ef(5 � -P f Rcumf 011:1ach #rccgrnpamesd rWLge 10 aiST Addl6unw Owners)
NEWkL' I-l2gcv V4roOdwi du luw 1-c[cphom 2g-624-1�M Fax 4
Ctmcnt M3 Hi rig A dtfres5 441 T 9fh Street 5E
Ci ry ffirkory .how North Caralma zip? � 2�32
CLin enI Street A&dress 1441 79M Strut 5E
ci ly F ockory Stake North -CariALrw zip �2&W-2-4w
PART B
1, P Lmf s) or firm(s) who aN hun rlc i u l Iv rosponsi b W fur thu land-disturbiTMg activity ( vi-de- $ fmmpr five list
ofali resporrsi ble Panics Qin atladi od Shan).
i7 Lv J lage{ Worldwide lnc E-nvji1:mdJremN+1�.SChn Derr hager�, Tl w�Q m
C ftlrt a Maili vg Addles I-0 T 154h Strcct 5E
cirjHkkory State
North Carolina Lip
A
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Cita c DFV 9"IC North Carollno Zgp ��?I -,,
T:le bMw EQM2A• )3nR yak #
2. Ca) If the rnanciFtlay Apr rdsif lr pdnu is not a residrm of North Cnroiink 8kwa :nri a :uM street b&tra" orthe
.dCsigFrowd Mw-th Co nol iru A gcnC
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Ow wj r diniIigg Achlrc-&%
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Curmnt Barer( A dre" F
alY Swc Zip
Tclephtu» rax.0
2, lb) ifr13e fnnrrru>11V +-6S,nAiblg ;Mtry is a PmwNhtp or othcr perwn engagirog td buwwss under assumed r�eFre,
ff11wh u copy' Mf the t=erWICRlc oFAmjktnLd Mama• If 00 financially rmpmulble pm ly 19 it C• if3lautl- aviv.r narne
W1b1 RJJCVI ad&Os trr'the Rnimu it Alrent:
N.143 4• 6? PlerL7v Fi-Food addm5s
Can I Mai i I Fljg .ASIreL-t 5E
City €$cory Stare Narch CsAW1Fw Zip MW2-4�32
Cw= Sweet s I" I , 9�h 5CM-et Sr -
city kftmr3+ Stare north rmVl1rn zip Bf 4332
TWephGM JQO-624,3300 Fax #
The ■hove Eehrm w1jun a& tr=.and Comm R7 [be best of my knowledge and briief iwd wM pnwi4e4 b, me urKWr oath (-Ns farm
mM-C be s9mad by rho 23ancbtUy mfx5r3&i ie pumua i f an inn iviiiu4 Lit hsn im-umey - ilk - Curd or if nm ;Mn iR&vw4aq, by CM off,
dire f-Gpr, partner ur regi wn� d agent with t -e aRtlIndly W1 cxcE utr 1R91rU1lle1][9 AN tht fJFWC3M1iY FeslsOrBible p�m'1. t ogres tiu
jrfovj&l Lun- cted info,�Itr�tion should 1hcr� NO MA' �h{in_1c 7n JhC iDtbr111atillm provykd JjkrMtn-
/724 ltr .
7' IT- i Tlil IC of th uFi t
10 04 7-
. a Notary Pub] i-C of the County -of �� � - Rtak� �f �otrh
'FXJJTIIliay fivcb} }Crtif} flag r y t.�, xl e� r _ apperc+d perarmffly betbm me this dad wid kxtlpg dulp
37kxDrn OrrlrrMV1:04-e 161 the a M ve &M arras executed by him-
Witncss my Land Lrvd tiol,%Fy peal. thI ,,, day 0� R A,
Seat!
r-MAA•-
Notary
My commission exfire, f1jij tKLe6 1 ,)oaq
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