NCC215951_FRO Submitted_20211028

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City of Jacksonville
Erosion and Sedimentation Control Application
Applicant(s): Military & Federal Construction Company, Inc
Address: 846 Bell Fork Road, Jacksonville, NC 28540
Phone Number: 910-353-3797
Interest in property: Owner
(Owner, developer, registered agent, manager, etc.)
2. ePlan Applicant Info: (Information of the person who will be uploading documents to eplan)
First Name: Kyle Last Name: Herring
Email Address: [e-mail]
3. Owner of Property: (Same as applicant)
(If not the applicant)
Address:
Fax Number: 910-353-3073 Email: [e-mail]
4. Description of property:
a. Location of Property/Address: 846 Bell Fork Road, Jacksonville, NC 28540
b. Onslow County Deed Book: 3488 & 5291 Page Number: 736 & 310
C. Onslow County Map Book: 24 & 79 Page Number: 218 & 28
d. Total Acreage in Tract: 1.37 & 1.60
e. Acreage to be Disturbed: 1.58
5. Submit the following documentation to Planning and Permitting:
a. One original fully executed Financial Responsibility/Ownership Form. (Attachment A)
b. One copy of a completed checklist along with all required information and documentation.
(Attachment B)
C. Check made out to the CITY OF JACKSONVILLE for the total amount due.
($225 for first acre plus $125 for every additional acre or portion thereof based on the
total disturbed acreage in the tract.)
d. Upload to eplan - Erosion control plan(s) along with all related details, calculations, and
documents as required on the checklist.
2/26/2021
Signature of Property owner or Applicant
Date

(ATTACHMENTA)
FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
SEDIMENTATION POLLUTION CONTROL ACT
No person may initiate any land -disturbing activity on one or more acres as covered by the Act before this
form and an acceptable erosion and sedimentation control plan have been completed and approved by the
Land Quality Section, N.C. Department of Environment and Natural Resources. (Please type or print and, if
the question is not applicable or the e-mail and/or fax information unavailable, place N/A in the blank.)
Part A.
I. Project Name: Military & Federal Construction Site Expansion
2. Location of land -disturbing activity: Onslow County City or Township: City of Jacksonville _
Highway/Street: Bell Fork Road Latitude: 34044'49.21"N Longitude: 77o 23'16.69"W
3. Approximate date land -disturbing activity will commence: Upon receipt of permit
4. Purpose of development (residential, commercial, industrial, institutional, etc.): Commercial
5. Total acreage disturbed or uncovered (including off -site borrow and waste areas): 1.58
6. Amount of fee enclosed: $ 350
The application fee of $225.00 for the first acre plus $125 for every additional acre (rounded up to the
next acre) is assessed without a ceiling amount. (Example: 6.4-acre application fee is $975).
7. Has an erosion and sediment control plan been filed? Yes ❑ No ❑ Enclosed 0✓
8. Person to contact should erosion and sediment control issues arise during land -disturbing activity
Name: Melissa Anderson E-mail Address: ]Waters@mafnc,com
Telephone #: [phone] cell #: n/a Fax #: n/a
g. 846 Bell Fork Road 846 Bell Fork Road
Current Mailing Address Current Street Address
Jacksonville NC 28540 Jacksonville NC 28540
City State Zip City State Zip
10. Deed Book: 3488/5291 page Number: 736/310 (provide a copy of the most current deed)
Part B.
1. Person(s) or firm(s) who are financially responsible for the land -disturbing activity
(Provide a comprehensive list of all responsible parties on an attached sheet):
Melissa Anderson, Owner
Military and Federal Cons. Co. jWaters@mafnc_.com
Name E-mail Address
846 Bell Fork Rd.
Current Mailing Address
Jacksonville
City
NC 28540
State Zip
846 Bell Fork Rd.
Current Street Address
Jacksonville
City
Telephone #: Cell #: Fax #:
NC 28540
State Zip

2. (a) If the Financially Responsible Party is not a resident of North Carolina, give name and street address
the designated North Carolina Agent:
Name
E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Telephone #: Cell #: Fax #:
(b) If the Financially Responsible Party is a Partnership or other person engaging in business under an
assumed name, attach a copy of the Certificate of Assumed Name. If the Financially Responsible
Party is a Corporation, give name and street address of the Registered Agent:
Melissa Anderson [e-mail]
Name E-mail Address
(Same as Landowner)
Current Mailing Address Current Street Address
City
Telephone #:
State Zip
Cell #:
City
Fax #:
State Zip
The above information is true and correct to the best of my knowledge and belief and was provided by me
under oath (This form must be signed by the Financially Responsible Person if an individual or his attorney -in -
fact, or if not an individual, by an officer, director, partner, or registered agent with the authority to execute
instruments for the Financially Responsible Person). I agree to provide corrected information should there be
any change In the information provided herein.
Melissa Anderson
Type or print name
4, �' -
Signature
CEO
Title or Authority
2/2,6/2021
Date
I, Q UL Vim(, l C . a C5 t .,rA ,a Notary K Public of the County of d
State of North Carolina, hereby certify that :]InQ,l rr � 5 5cA- .r5, i-�{% appeared personally
before me this day and being duly sworn acknowledged that the above form was executed by him.
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Witness my hand �o�ariN4 'his day of C_� , 20
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