NCC222103_FRO Submitted_20220606

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No person may initiate any land -disturbing activity,, on one or more contiguous acres as covered by
the Soil Erosion and Sedimentation Control Ordinance of the Ciiy of Greenville (Title 9. Chapter before
this form and an acceptable erosion and sedimentation control plan have been completed and approved by
the City of Greenville, Engineering Depar vent. (please tyke or print aud, if question is not applicable,
please place NIA in the blank)
PART a_m
1. Project Maine Kndle � prr .s �Plaase
2_ Location of land -disturbing activity: Township
3. Approximate date land -disturbing activity will be cotrimenced:._ alir 0,0 j
4. Purpose of development (residential, cornmercial, industrial, etc_}
Residenial
S_ Approximate acreage of land to be disturbed or uncovered:
G. Has an erosion and sedimentation control plan been filed? cs No
7. Person to contact should sediment control issues arise during land -disturbing
activities: Fen lWal ass
S. Landowner (s) of Record (Use blank page to list additional owners)
Rocky Russell Dei elopnient, LL
Narne(s)
106Regency Drive
Current Mailing Address Current 5ireet Address
Ga•eenville, NC 27850
_
City State Zip City State Zip
9. Recorded in Deed Book No. No : v
P T B
L(a) Person (s) or firm (s) who are financially responsible for this land -disturbing activity,
(Use blank page to list additional persons or firms)
Rocky Russell iDearelo2paeat_ _� :1
Name(s)
Current Mailing Address
G e-VviIIla P*t'v��L�i�1
City State Zip
Telephone C2,52) 3(,;X-Y
Current Street Address
Cite Stale Zip
Teiepi:one

%.(c) lr'dlie Financialiy Responsible Party is a Corpor-,rtron c6ve name and street address of
the registered aggelrf.
(Name)
Mailing iktlreSS
Street Addres.5
Zip ."-state Zip
Telp�alnone �� -��. �=r�le1}110i1G
Tile nbovt. lniormatrOn is true and corrcet to the, best of lily Lnowledge and belief and
-v,,ais provided by ine tinder oath. (This form niust be signet€ by the fimaicially responsible
;aersav if all inciivitlual or his attorney -in -,act or if not an individual by an officer, director,
, r bier, of registered a;ent with authority to ereeutP ti1stTu111ents for the flt7anci lly
sesponslble person). 1 agree to provide correried in ornui[lon should theme be any
chari,ge in the information provided herein.
Type, orprivhiln1e
ignatun"
Title or Authority
Date
_ l J t•i ! y i . €' �c l.•,` 1 a i,,lotai Public of the County of j�[ t•6
3taLe ofl lorCln Larolitna, hereby certify that
Liplacared personally before me this clay and being duly%sviFarrl ac',-llowledged that the
above fflorni vas exnctited by hire
1%r'rittess my hand and Notarial seal, this the i. ! day or 6.: I 2021
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Notal-y
illy cornrnissjon expires