NCC220831_FRO Submitted_20220218

OKnu[ TOWN ur ENGINEERING DEPARTMENT
dolly 128 South Main Street - PO Box 8 Holly Springs, NC 27540
Springs [phone] • FAX [phone]
7 (1 li 111 CAR01, IN A
Application for Construction Drawing Plan Approval, Erosion & Sedimentation Control Plan Approval, NPDES Stormwater
Review, Land Disturbance Permit Issuance, and Statement of Ownership and Financial Responsibility:
(Check All That Apply)
(] Construction Drawing Plan Review Erosion & Sedimentation ❑■ NPDES Stormwater Review
Control Plan Review
1. Project Name, Project ID, and Phase: Holly Springs Business Park Tract 3 Phase:
2. Description of Construction/Land Disturbance:
Commercial Site/ Land Disturbance 14.82 AC
3. Landowner(s) of Record: (Use additional pages if necessary and attach to application)
Skie Properties
Name
PO Box 938
Address
Holly Springs, NC 27540
City, State, Zip
Name
ress
City, State, Zip
Telephone Fax Telephone Fax
919-7954753 [e-mail]
Mobile Phone Email Address Mobile Phone Email Address
4. Future Landowner(s), If Applicable: (Use additional pages if necessary and attach to application)
Name
Address
City, State, Zip
Telephone
Fax
Telephone
Mobile Phone Email Address Mobile Phone
5. List Book & Page where Deed or Instrument is Filed in Wake County:
Location Description: TR3 GREEN OAKS PARKWAY BM2006 -02524
Name
Address
City, State, Zip
Parcel Identification Number (PIN): 0649121571 Tax Map, Block, and Lot Number:
Book: 017798 Page: 00688 Book:
6. Person(s) or Firm(s) Financially Responsible for Land -Disturbing Activity
Skie Properties
Name
PO Box 938
Address
Holly Springs, NC 27540
City, State, Zip
Telephone
919-795-4753
Mobile Phone
9001
5/2/14
Fax
[e-mail]
Email Address
Name
Address
Fax
Email Address
Page:
City, State, Zip
Telephone
Fax
Mobile Phone Email Address

Application for Construction Drawing Plan Approval, Erosion & Sedimentation Control Plan Approval, NPDES
Stormwater Review, Land Disturbance Permit Issuance, and Statement of Ownership and Financial Responsibility.
7. Registered Agent, if any, for Person(s) or Firm(s) Financially Responsible:
(NOTE: A North Carolina agent is required if the applicant is not a resident of North Carolina.)
Name
Address
City, State, Zip
8. Plans Prepared By:
Underfoot Engineering, Inc. / Mike Roselli, PE
Name of Firm/Person
1149 Executive Circle, Suite C
Address
Cary, NC 27511
City, State, Zip
Telephone
Mobile Phone
Email Address
919.696.0830
Telephone
Mobile Phone
[e-mail]
Email Address
9. Site/Project Information:
Total Size of Tract: 14.82 acres Area Disturbed: 11.16
Length of Sidewalk: 3400 linear feet Length of Streets: 1600
Length of Water Line: 2630
Length of Greenway: N/A
Fax
Fax
acres 486,343 ft2
linear feet
linear feet Length of Sewer Line: 1640 linear feet
Length of Stormwater: 4210 linear feet
# Stormwater BMPs < 5 acres: 4 # Stormwater BMPs > 5 acres:
Latitude: N 035.390623 Longitude: W 078.514058
FEMA/FIRM Map #: 3720064900J Panel #:
0649J
Total Post Development Impervious Surface:
10. Approximate Date Land Disturbance Will Begin:
11. Signature and Wi ess: The above information is true and correct to the best of -my knowledge and
belief and was p d by mew He under oath.
Signat a of erson i ncially Responsible Type or Print Name Legibly
\ Title or Authority Date
I, a Notary Public of the County of hereby certify
that -t _ personally before me this day and under oath acknowledged that
this Application for Construction Drawing Plan Approval and Erosion & Sedimentation Control Plan Approval/Land
Disturbance Permit Statement of Ownership and Financial Responsibility was executed by him or her.
Witness my hand and notarial seal, this —2 day of f, I 20-�.
gnature of Notary Public My Comaiission Expires
Effective Date: May 2, 2006
SEAL
KELLY DUNBAR
Notary Public
°'�t North Carolina
..' Wake County
9001
5/2/14
323,080
FOR OFFICE USE ONLY
Date Completeness Verified:
Project Number: PN-
Fees Paid:
❑ Construction Drawing Review Fees
❑ Erosion & Sedimentation Control
Plan Review Fees
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