NCC221659_FRO Submitted_20220427

PLAN REVIEW/FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
CATAWBA COUNTY CODE OF ORDINANCES, CHAPTER 16 ARTICLE V
SOIL EROSION AND SEDIMENTATION CONTROL
No person may initiate any land -disturbing activity on one or more acres as covered by the Ordinance before this form
and an acceptable erosion and sedimentation control plan have been completed and approved by the Catawba County
Utilities and Engineering Department. (Please type or print, and if question is not applicable, please N/A in the blanlz)
PART A
1. Job Name Short Road
2. AN or 911 Address 371119615646, 371119628108, 371116726809, 371116844173, 371116837965, 371116849988
3. Purpose of development (residential, commercial, industrial, institutional,etc.)Residential
4. Approximate soil disturbance date June t, 2022
5. Total acreage disturbed or uncovered (including off -site borrow and waste areas) 185
6. Has an erosion and sedimentation control been filed? yes NoX' Attached
7. If you have an Erosion Control billing account, would you like this to be billed? F Yes R' No
Account Number N/A
PEOPLE
8. Person to contact should erosion and sediment control issues arise during land -disturbing activity
Name Eric Yeargain E-mail address [e-mail]
Telephone [phone] Cell # N/A Fax # N/A
9. Landowner(s) of Record (attach accompanied page to list additional owners)
Name C Group, LLC, and RECL NC, LLC Telephone (NIA Fax # IA
Current Mailing Address PO Box 3916
City Hickory State NC ®Zip 28603
Current ,Street Address 3050 First Ave. Ct. S.E.
City Hickory State NC Zip 28603
10. Deed Book No. 3642 Page No. F136
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 attached sheet):
Name RECL NC, LLC E-mail address [e-mail]
Current Mailing Address 050 First Ave. Ct. S.E.
City Hickory State NC Zip [28602

Current Street Address 3050 First Ave. Ct. S.E.
City Hickory State NC - Zip 28602
Telephone [phone] Fax # IN/A
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 NIA E-mail address N/A
Current Mailing Address N/A
City N/A State N/A Zip
Current Street Address N/A
City N/A State N/A Zip [N/A
Telephone N/A Fax # N/A
2. (b) If the financially responsible party is a Partnership or other person engaging in business under 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:
Name Eric Yeargain E-mail address [e-mail]
Current Mailing Address 3050 First Ave. Ct. S.E.
City Hickory State NC Zip 28602
Current Street Address 3050 First Ave. Ct. S.E.
City Hickory State NC Zip 28602
. ... ...... ..
Telephone [phone] Fax # N/A
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.
ji
ype or Print`Nainl e Title of Authority
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_.
Stgfiaire Date
I, L U D ASOLL -- , a Notary Public of the County of State of North
Carolina, hereby certify that . - �Ag. j Q appeared personally before me this day and being duly
sworn acknowledge that the above form w s executed by him.
Witness my hand and notary seal, this 4- day of , 2
Seal _
SUSAN J wiLSON Notari rY Notary Public My Co Sion expires 0 t3 -
North Carolina
Catawba County P�lattFtsim
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