NCC222360_FRO Submitted_20220708

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 NA in the blank)
PART A
1. lob Name Macleod Construction Portable Concrete plant
2. PIN or 911 Address 2880 Main Ave, SE
3. Purpose of development (residential, commercial, industrial, in titutional,etc.) Industrial
4. Approximate soil disturbance date June 2022
5. Total acreage disturbed or uncovered (including off -site borrow and waste areas) F
6. Has an erosion and sedimentation control been filed? r Yes f No r Attached
7. If you have an Erosion Control billing account, would you like this to be billed? 0 Yes fx No
Account Number
PEOPLE
8. Person to contact should erosion and sediment control issues arise during land -disturbing activity
Name Bob Macleod E-mail address [e-mail]
Telephone [phone] Cell # [_ Fax #
9. Landowner(s) of Record (attach accompanied page to list additional owners)
Name Macleod Family LLC Telephone [phone] Fax #
Current Mailing Address IP.O. Box 320
City DENVER State NC Zip 28037
Current Street Address
City State Zip
10. Deed Book No. 3701 Page No. 1051
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 MACLEOD CONSTRUCTION INC. E-mail address [e-mail]
Current Mailing Address P.O. Box 320
City FNVER State NC Zip 28
037

Current Street Address
City State Zip I
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 E-mail address
Current Mailing Address
City I State Zip
Current Street Address j
City f
Zip
Telephone Fa4 #
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 E-mail address
Current Mailing Address
State
City State I Zip
_ ... _..._ .......... .................
Current Street Address
City --State Zip r
Telephone �Fax
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 ould there be any change in the information provided herein.
e, C/", 1
Type or Print Name Title o Au hority
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Signature Date
I, M ICNA€L L. NoUgeR , allotary Public of the County of CA171WER State of North
Carolina, hereby certify that (Zo&O i 1AAe. 1--)-0 appeared personally before me this day and being duly
sworn ac�4ioy ledgp,that the above form was executed by him.
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WOP.my hand ar�.�ot seal, this day of �(,�/�/� , 20,14
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CO Print Form