NCC221939_FRO Submitted_20220523

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 blank)
PART A
I . Job Name Dollar General -Claremont, NC
2. PIN or 911 Address 1376009261827, 376009271032 & portion of 376009169901
3. Purpose of development (residential, commercial, industrial, institutional,etc.) Commercial
4. Approximate soil disturbance dater June 2022
5. Total acreage disturbed or uncovered (including off -site borrow and waste areas) 2.45 acres
6. Has an erosion and sedimentation control been filed? F Yes F No FX Attached
7. If you have an Erosion Control billing account, would you like this to be billed? Yes , No
Account Number F
PEOPLE
8. Person to contact should erosion and sediment control issues arise during land -disturbing activity
Name Joe Strickland E-mail address [e-mail]
Telephone Cell # [phone] Fax # 1
9. Landowner(s) of Record (attach accompanied page to list additional owners)
Name Gary Michael Huffman Telephone Fax #
Current Mailing Address [4972 Elmore Drive
City [Catawba State NC Zip F28609
Current Street Address 4972 Elmore Drive
City [Catawba
State NC Zip 28609
10. Deed Book No. 3213/1708 Page No. 0761/0418
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 FTeramore Construction, LLC
Current Mailing Address 1214 Klumac Road -Suite 101
E-mail address [e-mail]
City Sallsbury State NC Zip 28144

9. Landowner(s) of Record (attach accompanied page to list additional owners)
Name James Steven Turner Telephone Fax #
Current Mailing Address 447 Frank Edwards Road
City West Jefferson State INC
Current Street Address 447 Frank Edwards
City WestJefferson State �NC
10. Deed Book No. 1708 Page No. 1418
Zip 28694
Zip 128694

Current Street Address 214 Klumac Road - Suite 101
City Salisbury State NC Zip 28144
Telephone [phone] Fax #
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 F_ E-mail address ^ T
Current Mailing Address
City I State F_
Current Street Address
City r State r
Telephone Fax #
Zip
Zip I
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 �
Current Mailing Address
City
Current Street Address F
City
E-mail address �� r
State
State I—
Telephone � Fax #
Zip
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 istered agent with the authority to execute instruments for the financially responsible person). I agree to
provide correcte i ormation should there be any change in the information provided herein.
Joe Stricklan - eramore Constructlon Manager
Type or Pr' ame W Title of Authority
1�z y
Sig u Date
I, _ 1 I✓ �- %� . �! L Mr¢ViV a Notary Public of the County of I2 0 ln14 M G 4 V Atr 7 State of North
Carolina, hereby certify that appeared personally before me this day and being duly
sworn acknowledge that the above form was executed by him.
Witness my hand and notary seal, this I�tTH day of F rz3 fZV-4-Z 7 20
DAN IEL R AI..MAZAN
Se NOTARY PUBLIC .
Rowan County Notary
Norge Carolina 5 uNr
My Commission Expires June 25J2022 My Commission expires
Print Form

Office: 828-465-8161 PO Box 389
Fax: [phone] Newton, NC 28658
www.catawbacountync.gov pW
catawba county
utilities & engineering
Application for Erosion Control Permit
PROJECT NAME: Dollar General - Clare rlont_ _ SOIL DISTURBANCE DATE:
PROPERTY LOCATION (Property ID #): 376009261827, 376009271032 & portion of 376009169901
PHYSICAL STREET ADDRESS: TBD NC Hwy 10
PHYSICAL DIRECTIONS TO JOB SITE: Approx. 500' from the intersection of NC Hwy 10 & SR 1801
FINANCIALLY RESPONSIBLE PARTY (Name): _ Teramore Construction. LLC,
Address: 214 Klumac Street - Suite 101 Salisbury NC 28144
704-224-7364 city State Zip
Phone: Email address: [e-mail]
CONTRACTOR NAME: Teramore Construction,,LLC
Address: 214 Klumac Street - Suite 101 Salisbury NC 28144
Phone: [phone] City State Zip
Erosion Control Account #
Number of acres disturbed: 2.45
Type of Use:
( ) Accessory (} Assembly , Business
(} Condominium
O Institutional
() Multi -Family Residential
(} Residential Townhouse
O Subdivision
Type of Work:
O Additions
(} Roadway Construction
Puroose of Development:
(' ;ommercial
() Residential
Signatu
(} Education
O Mercantile
O Other/ See Description
(} Single Family Residential
(} Two -Family Residential
O Demolition
( ) Utility Construction
() Industrial
(} Church
(} Factory/industrial
(j Modular
(j Residential Hotel
(j StoragelWarehouse
{) Utility
New Building Construction
O Institutional