NCC220842_FRO Submitted_20220222

WATAIUGA COUNTY Department of Planning & inspections
126 Poplar Grove Connector Suite 201 • Boone, NC 28607 + Phone:[phone] a Fax:[phone]
GRADING PERMIT
APPLICATION
ALL APPLICANTS ARE RESPONSIBLE FOR OBTAINING ANY STATE
OR FEDERAL PERMITS IF APPLICABLE.
DATE: ( ll►&
PROPERTY OWNER: Scout, Inc
ADDRESS: 183 Old Turnpike East Road
PROPOSED PROJECT LOCATION: off of Hwy 105 Bypass
TAX PARCEL #: 2900063286000
PHONE: (828 ) 898-6577
CITYBanner ElkSTATE NC ZIP 28604
GRADING CONTRACTOR: H3 M (,:4)cnskYAx;cmyi- I&nnex LICENSE#: toWIU-?
ADDRESS: O � syC U q S 4y\y A 1-, Ai G Z Klp1)W PHONE:
PURPOSE OF GRADING: NOSPWIVE 690144 ESTIMATED COST: $ ZC), 600
HYDROSEEDING? �-Mj>
AREA TO BE GRADED: (approx acreage) (g.17%t % Ades HANDSEEDING ? _7W.
NUMBER OF FEET OF STREAM(S) MRACTED? (If applicable): MA _
EXPECTED START DATE: Z. I S I ZdZZ EXPECTED COMPLETION DATE: Z / S / 20�J
The undersigned agrees to conform to all applicable laws of the County of Watauga
and the State of North Carolina: nd fu ther states that all statements made hereon are true,
APPLICANT SIGNATURE J DATE SIGNED
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PERMIT FEES $
PERMIT DATA REVIEWED BY:
EROSION PLAN REQUIRED?
PLAN REVIEW BY:
PERMIT ISSUED BY:
OFFICIAL USE
PAID? DATE
YES/NO
DATE:
LICENSED CONTRACTOR RE, Q?
PLAN APPROVED BY:
DATE ISSUED:
PERMIT VALID UNTIL:

APPENDIX D
FINANCIAL RESPONSIBILITY /OWNERSHIP FORM
SEDIMENTATION POLLUTION CONTROL ACT
No person may initiate a 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, NC Department of Environment, and Natural Resources. (Please type or print and, if question is not
applicable, place N/ A in the blank).
Part A.
1. Project Name Hwy 105 Bypass Site
2. Location of land -disturbing activity: County Watauga
City or Township Boone , and Highway/Street Hwy 105 Bypass
3. Approximate date land -disturbing activity will be commenced: 2-5-2022
4. Purpose of development (residential, commercial, industrial, etc.): Commercial
5. Total acreage disturbed or uncovered (including off -site borrow and waste areas):
6.97 - 7 acres
Amount of fee enclosed $ 1,050.00
Has an erosion -an/d sedimentation control plan been filed? Yes No
Enclosed V
8. Person to contact should sediment control issues arise during land -disturbing activity.
Name John Garner Telephone [phone]
9. Landowner(s) of Record (Use blank page to list additional owners):
Scout, Inc. [phone]
Name(s) Telephone Fax Number
64 Utopia Lane 183 Old Turnpike East Road
Current Mailing Address Current Street Address
Crossnore NC 28616 Banner Elk NC 28604
City State Zip City State Zip
10. Deed Book No. 2237 Page No. 681
Part 13.
Person(s) or firm(s) who are financially responsible for this land -disturbing activity (Use a blank page to list
additional persons or firms):
Scout, Inc. [e-mail]
Name of Person(s) or Firm(s) E-mail Address
64 Utopia Lane 183 Old Turnpike East Road
Current Mailing Address Current Street Address
Crossnore NC 28616 Banner Elk NC 28604
City State Zip City State Zip
Telephone [phone] Fax Number

2. (a) If the Financially Responsible Party is not a resident of North Carolina, give name and street address
of the designated North Carolina Agent:
Name E-mail Address
Current Mailing Address Current Street Address
City State Zip City State zip
Telephone Fax Number.
(b) If the Financially Responsible Party is a Partnership or other person engaging in business under an
assumed name, attach a copy of the Co3rtificate of Assumed Name. If the Financially Responsible
Party is a Corporation, give name and street address of the Registered Agent:
Name of Registered Agent
Current Mailing Address
City State Zip
Telephon
E-mail Address
Current Street Address
City State Zip
Fax Number
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.
HOLM. &gf v\4eA✓
Type or Print name
IUM'U
ignatu
Title or Authority
Date f
I, .iA �,Ale_�a L- `F c<\+nl_%'.r. , a Notary Public of the County of P\'jecy
State of North Carolina, hereby certify that NACA c r appeared personally
before me this day and being duly sworn acknowled ed that the above form was executed by him.
Witness my hand and notarial seal, this day of Neyem b , 20 Z 1
hlayley L. Franklin
NOTARY PUBLIC -
AVERY COUNTY Notary
Narollna
My Carnmisslon`E'x`p�re', � W 26
ay_�.. My commission expires. LA, ?_o ?__(.Q

AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION
Property Deed
Book 2 2 3 7
Page ($ 1
PIN: 2900063286000
STREET ADDRESS: Off of 105
Property Owner: Scout, Inc
The undersigned, registered property owners of the above noted property, do hereby authorize
Agent of BREC, PA _
to act on my behalf and take all actions necessary for the processing, issuance and acceptance
of this permit or certification and all standard and special conditions attached.
Property Owner's Address (if different than property above):
183 Old Turnpike East Road
Banner Elk NC 28604
We hereby certify the above information submitted in this application is true and accurate to
the best of our knowledge,
uth ri ed Signature
Date:
Print— Name, Title