NCC222671_FRO Submitted_20220725

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 X/A in the blank)
PART A
1. Job Name Huffman Property Subdivision - Initial Erosion Control Plan
2. PIN or 911 Address PIN 371105188157
3. Purpose of development (residential, commercial, industrial, institutional,ete.) Residential
4. Approximate soil disturbance date March 2022
5. Total acreage disturbed or uncovered (including off. -site borrow and waste areas) 22.7 acres
6. Has an erosion and sedimentation control been filed? f— yes F No C Attached
7. if you have an Erosion Control billing account, would you like this to be billed? F yes F No
Account Number NIA
PEOPLE
8. Person to contact should erosion and sediment control issues arise during land -disturbing activity
Name Doug Huffman Email address [e-mail]
Telephone [phone] Cell # F Fax # i
9. Landowner(s) of Record (attach accompanied page to list additional owners)
Name Huffman Equipment Leasing LLC Telephone [phone] Fax #
Current Mailing Address 2608 Springs Rd NE
City Hickory State NC Zip 28601
Current Street Address Same as Mailing Address
City State Zip 9 .
10. Deed Book No. 2293 Page No. 6ss
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 Doug Huffman, Huffman Equipment Leasing LLC E-mail address doug@huffmangrading,com
Current Mailing Address 2608 Springs Rd NE
City Hickory State NC � � Zip F
8601

Current Street Address (Same as Mailing Address
City State Zip
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 NIA E-mail address
Current Mailing Address
City State
Current Street Address
CityF_ State
Telephone
Fax #
Zip
Zip
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 NIA E-mail address
Current Mailing Address
City I State
Current Street Address
City State
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 registered agent with the authority to execute instruments for the financially responsible person). I agree to
provide corrected information s uld there be any change in the information provided herein.
a [c /J7 mac/` 4 to 4 E r-
T or P N e Title of Authority
Signature Date
, Lhri ssu W . He
Carolina, her6by certify that aUc
sworn acknow�ledg' rVtl /above fdi
Witness rand and�tN�otarv9eal� this
U rdotary t+l�''
11 C4ta.;�bit CountYlres
Y commission Exp =
-------- ----
a Notary Public of the County of 0-afaca6& State of North
._ /t-1`A W an appeared personally before me this day and being duly
was executed by him.
1g4-h day of Jan Ltar Y , 200}a
expires U I0 a a4a
Print Form