NCC221209_FRO Submitted_20220328

antl-1)islitIbill
l;
�� w rr • w u • + . l'Crillll Applicalioll
I'L•,ase;omrl:t; Iti+rh I�,I�rs rf Ibis lima andreturn In:
dress Mailine \ddres-.
$n 1 .►.t st, I'll Hot, 5Is
Pitl•har, \C 27312 I'iltslxao, NC 27312
I`h+vac: (ON) 54c4268
Plc.a.c "x I+1 R\111 I ING I HM ('11AR 1' to deten„inc as hick rcrmil and plan rcalnircmcnts arrlk L+
� olv rrojc:t ,and then ehcA one of the hoses bcloaa :
Q✓ Land-Ilislurbing Permil. the (011oasing items are required In ohlain this pen„it: c-+naplctcd
'rrlication. plans, deed, and fees. I ;and-Ilisttuhinc Permit applications must include all parcels'
lots on one application %sill, the tolal amount of disturbance filr all parcel/lots. All clearing and
disturbance muse be included %%lien ealculaline disturbed area.
Fee Requirements:
1 Pennit Ice: S250 di•tuncCd acre
Plan l(c%lc%N I cc: S_'q) di.rurilt-d ncre I
I ccs are rounded up to the nest %%hole acre.
_[_\ample: I acre or Icss is S500, 1.01.2 acres is M.000, and 2.01-3 is S1.500.
Plan Reatlircmcnts:
Dt-ien Plan: submit (1) copy ofan erosion control plan completed K scaled by a professional land
sun cs or. professional engineer, or rcgistcred landscape architect. This plan must meet the criteria of the
Chatham Count, Frosion Control Plan Revie\a Checklist and include all applicable construction details.
I hesc can he found on the Chatham Count), Watershed Protection %%ehsite, on the Erosion Control
aachpagc. This plan must satisk all local, state, and federal minimum plan requirements.
General Plan: submit ( I ) cope of site plan along %%ilh the Chatham County Residential General Plan. Site
plan is not required to he completed by a design professional. The Residential General Plan can he found
on the Chatham Count-. Waterslied Protection vwhsitc on the Residential Construction %kehpage. Indicate
lot drain3,-+c nattern(s) on sheet I of the Residential General I'lan.
11midenlial Lot ['email. the lill1cminr items are required to obtain this pem,it: completed
application. site plan. anti fee. PAGF 3 -FINANCIAL Rl SPONSIIIILI IN OWNERSI111, 1 ORM"
not required.
I cc Requirements:
S 1(00 Ilat fee
Plan Requirements:
Site flan shoaling properli boundaries.] he site plan required by the
Environmental I Icalth or Central Permitting Departments is sufficient.
AIJ.CIIF.CKS11:\I,1'P\1 \I111: 14)UII\1-11\\1('01.AIY
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prriris grim M rh„ O'Al A11,+„inr the namaciAlh tryomoble pwrl► prl,fin I,+Imn,lmI Ihr IAnd ,H,Inrl,tnq $fllrlit ne
t be corer" -
1'►.' Ycir -, %mr- Ommrnprs Club • Lot em _ 10 % 11': 1 !► !1
t[►IsRI'�� or rRomT: 3,2W1 AnAdaiiii, Ctwlpel Mills MC 2751?
I.►TITthC1OM-.1Tt•11t'01-1'ROITRIYATSUEF.-IIt,1JSA9AAA 49(1',51!
p%RCFI.•lsol:
Tt}T fit. DINT+ RRFD %CRrS r. SQVARE FFF.T: 0.65
rt Rr(►ss�F (IF \('TI\ IT1': NewSFD — _ -
FFF ►NIOVNT Nt'R%11TTFD: 5100
•' I \\i1(11l'\FRIG? (Ir RFC(1RD ottach pace to Ii%l addiliunal tm rim
f 1.3-Lc FA,% idc a comhlcte lict of harincrs, managing mcmhers and regki rcd arcnls if Ihr rc%i Ainihle cnlils or
i tan;f o%%ner is a poup of indis ideal+, corpom. is organivatiun or cntit).
l Nathaniel Phone: l Tyler 585-478-1240
98102 Drummond E-Mail; [e-mail]
t Chapel Hill, NC 27517
'•FI\-1\( %1 I Y RFSPt1\Sl1ll_F PARTY (applicable onlifilifTercnl from pro
4 ti3RSe Phone:
Ij Address: E-Mail:
signalure:
NOR I I C•1R01.1NA AGENT (apalicahle only iIFoHner or financially recrnmsihle partdoes not rr•ide in
North Carolina
Name: Phone:
Address: r-Mail:
Signature -
I : VOINITRiS1 !R VL Y(1R
('nmram Nan►e:
Address:
Ovnt3cl Person:
1'I,nne:
EROSION CONTROL
Person to contact should erosion & sediment
control issaessrise during land-disturbing,-acti,il,:
Contact Person: Alan Keith
Company Nang: Diehl + Phillips
Phone: [phone]
I! -Mail: arkeith [e-mail]
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OWNER OF l ROrr.RTV:
Name and Title: _N J—
Comrarn tifapplicabic):
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ADDITIONAL FINANCIALLV RESPONSIBLE PARTY (ifany):
Name and Title:
Company:
Signature- --
NORTII CAROLINA AGENT (if any):
Name and Title:
Company: _
Signature:
1—T:.. i t �__ , a Nulary I'llhlic of t �.1�_[� {'aunt►' in the %tale
of V ill do hcrchy certify Ihal_NA,jiLr ---jy/[I' p.r.unally
appeared before me this day and under 0;1111 acknuw lodged reading the infnnnaunn al►Itvc tend acknotti ledged that the
abo%a form • . c •cuicd by him or her.
Witncss y han and off seal, his the !I day of
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Nly +Irnmission expires 1 'ail �.� � 1�1 11 f ; O ot•t11t-� •._'_
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