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Home My WebLink AboutNCC222947_FRO Submitted_20220817040 4F 1 1% City of Winston-Salem/Forsyth County Inspections Dilvi ion i W9 1 Oil L Fl"r st Street, Suite 328, Winston-Salem. N ( 271 [11 I In-EC6HS __10H Financial ResponsibilitylO +nelship Forrn Erosion Control Ordinance N o person may in i 1i ante any land-di,�tu rbi ng etc t i vity exrccdin g }(l,NX) xy ua re J eet for a Sits ale -fain i l Y d welling or 10,((}U square f et�t for an v cal he r V ar se_ he We this fig rm a rid an acice ble -erosion and sed i rlwnat ion contra l p] are have been complet-ed a.rld approved by the F.rcwi Gn Cu ntri i I Sc:c tiirn t)f th v C i I y of W in sion-Sai cni Furs yth County ry Inspections Division. Please type or print. if ,� gtj ion is not applicable, please place "NA" in the hi an k �pav :. PART AL rroject -Name; hipotle Peters r k p Perini, # 1 -351._.._............_.._.._.._.._.._.._.._.._.._.._.._.._.._.._.._..__..._ . ._.._.._.._.._.._ .,-_....._. .. _.._.._.._.._.._.._.._...._. , _.._. ............_.._.._.._.._ 1AWA600 of Land-IhAurbing Aciivit . LxIiIudc 36" 245,19"N 1051 outhpark Blvd., Winston-Salem, N 27127 ............... _.._.._.._.._.._.._.._.._.._.._.._........_.._.._.._.._.._.._.._.._....... ...... ......................................... Lanai I u& 80' 15'33.45r .Appro%ilriale Dale to Coromance Land- Dim rhing Acti013-: Pu rpaw of GradinK. Cuin rri�r ri nt 9 Ot11er tNo dvti6opnienI propo-.0) 08115120 2 9 Residential Nl u Iti-fa mile 9 Res idVIN11a.1 Sine Fami1� 101 9 Residential' np.Ie FarrAh Suhdivislon Total She Acries-r: 0-7-5 r :� t� ire hi? D1%turbriL 1.40 AC f t-r-mir F.L•;:: Parson to -con lact s1wuld cros%on and sedintenI carllrA ksrw� arriw during Iand-.01,Iui IPiult acili it% Namt Michael , LaRue E-mail addrng ,.,!A!AA g� Iqruedevel, !Y.}�9t,Pqrrl_. Teleph-orlr cell # I .:m odau-ner 4vf Reford (use blank page i* fig add11lonal aw ners)t C L O. Inc. _................................ - - - - - - -._.._.._.._.._.._.._.._.._.._.._.._..� - -....--.._.._.._.._. Name -nerx phon-e 4 0 L0 I~f fi Street Addreasir.u. joax ..................................................... - - - --.._.._.._.._.._.._.._.._.._............... . Na me Owneirs phrane I# ......... ,....,... ,_............................ ............................. Sir W Add r sVr.c . Una WIN TON ALEM, N 71�1 C i r�; State?Z i p C M a Cityl.9ta reiZi p Cade 'Iwi Block H: Tax I.ot #: 682-77-99-DO ;rnnin: GI3- .._. _. _....... ZAniag Appro;-al: -3519 Ciurlruelor Informatirprr li equirrd Prior tri Piwriri linvani• +rrh 'ar�ili�Fa #�rrr f.a+�� rc �rr� r r rrrr�r'rr;•f�� ti err �rrsrd rtirp��r�S� na +guar +w rt� a 3 + �r+ad Argher, .411 caturarra r•s mum pia tie a C kv of Winwrut-Nah+m crm rrarjor '.1v IDP, avaifahfe ar ito eosr fhrrngh rh e Cizy '.k Reveii me Offlce. S 11 Vatut of CrAdIng Contract _116 Nxmt nr Prim$n- . piica-nr iC ratiin rsntract7or) S I rre I W _� �It�rtat�.r�l� G� q2.3 g� City'Uanirac7r'1 # Coffitra r1cpr's '�_ �'+ riomst NUMINrr*-W iz_ — 4 45'1! K MN erotic lemma ' i lea v i m r Phone h u m her _ Perti 8) ur fiml(sI who are fill anuall� responsible fDr Ihis land -d isl orb Ln g acIivity f use bLan k pageI-D IV I addilior6ul pm m� rx firam). Contractom are nul carts ide r fi micial I y ms ponsib le for properl v w Mind er I hci r ow ncmh Lp. R & M Development Services. LL Nonw of inn ar Firm Aquavriew Drier St rev l Add rewfF.O. Box ... 7e.rs. ri.11gI. _. N. ........ 27284....... I ....... - ................ _... 336-317-0401 _ _...... _...... ....................,. aKylIme Tefeph(ine It ..._.._.._.._.._.._.._.._.._._...................._.............._ . We n f FeFinn oT F i rm Street Addren�P. _.. ...,, .................... ,....... .... - - O. B9x l it •. �1 ;i I L• �.Ip�Co+de ...........,.....,..,,.,,.,,., ., ., . . ........ _._............................... D + Ili i uv l v iephone # . I f the G nancid ly TCSrKWI', i FBI u pare• i % aFi i pu t-of- state tesidem. give the naaw and m reil dress of tivl� nag Lstr red i n-sl a he agen t. .._..............._.._.._.._.._.._.._.._.._.._.._......._.._.._.� -._..__......_...........�.............. ............ 1.................,. ._.._.._.._, .,_., _._..._.._.._.._.._.._.._.. Name of I w Repkiered Agent ciryl%A-111 /Ip COde ...._. ._.._:._.._.._.._.._......_:._.................................... _.._. _ _........_ ...._.._.._.._..,.. 4 ........................ -------_...._.._.._.._.._.._.._.._........_._........ S f reilt Arid rPK-dP.� F. Rn,i 17a I i I ne .i 4- I c phone 4 i If Ihc naix: ia] I e a r. n�ibl� pgrlY i s u r arUWF6h ip. g i vC flIV 11aine M1 , # .�. !; L�! b9 a rtik page to list �tdi itio11 a 1 partners). hAi��l . Lae _.._.._.._.._.._.._.._.._.._ ................. ........... ................ ... -.--.� . N zm a 4Fr the fcaerail Ira rta r Nvk me of th a Gc ri-eral Part ner 940 j uaview Drive ..... .................................. _. _ _.........._.._.._.._ ._.. ._.._... .............tt t . �I �l r. �a.................._.._.._.._.._.._.. - - - - - - Street AddresyR.O. flex E ernl.&rs�_iII..�.._......N .27 5 ..,..,.._.._._.._.._...._._............................ .............._..............................._._._._._._._._.............,......_,_,. C its iNtaWLI p Cod a r i[y�tq t07iti O P& �.._.._.._....._.._................................................ _ Da vtl rem •f,Dl&p hang 0 Daytirri-P Tek ph on c 4 Tie a wt i nfbi-ni al ion is true and correcl to The keatl cif my knowledge anti hel ief and was prrwidcd by me undcr oa I hr. [Th ir, formal must be sign by th a f na nci &I ly rcxriomsil bi c perm 1 f a n individU91 0 r hi s ativrncy - ill- fi.L' I ur if Tiol Sul lath %.-i dual b} an v M cu, J (rector, p 3 rl M-r W T—q ixWMA HUL:n t W1Ilk -a Lil Nil ity to execs le insi ruinvi1Is for the f i nano is Ily re',p,, ns iblc perq, n.; I agree to prov id c earrecied I nfanrLai 1 rm shuu Id there be any change in the i nfonmta nri prc-r ided herein. I.cI . ................_._._._._.. went .............................................. T *Wpit a r Pri' Title or.A r h ri torei ■;� Date . _ ....� .�.. ............ . a Notary. Pubiiv ikf aw comity of ........ ............ ....................................... _ 51il-: of North Cawlina� du hereby ccrtdt that ------ �_., ..� �. ------- LO__r_u_--e ....................... appeared per.%onai l I y be I ore me Iris day and 'hei ng July %worn ac k nowiedge d i hm the above form wa_s ex ecutcd by him. W UMSM my hand and n marial Kcal. (his d a V or 2 � - _- ....... r...__.�.�_.. j.,... ..................� .0 tary P11 ANGEL G. i IATT WUuy - a r�