NCC224080_FRO Submitted_20221213

applications mar be submitted online-
s L tts: chathamcount%nc.,ieH intckoud.com,'cate pries 108
Land -Disturbing
U16A IIAM CC3UNTy permit Application
v e/ N i ►/ L A R !'■ ■ i M A
Please include all required signatures. F!2rOffice Use:
Physical Address Mailing Address
80 East St. PG Box 548
Pittsboro, NC 27312 Pittsboro, NC 27312
Phone: [phone]
Please see PERMITTING FLOW CHART to determine which permit, plan, and fee requirements
apply to your project and then check one of the boxes below:
Q hand -Disturbing Permit. The following items are required to obtain this permit: completed
application, plans, deed, and fees. All clearing and disturbance must be included when calculating
disturbed area.
Fee Requirements:
See attached PERMITTING FLOW CHART
For fees that are rounded up to the next whole acre.
Example: 1 acre or less is $500, 1.01-2 acres is S1,000. and 2.01-3 is S1
Plan Requirements:
Design Plan: submit (1) cop} of an erosion control plan completed & sealed by a professional land
sur►e%or. professional engineer, or registered landscape architect. This plan must meet the criteria of the
Chatham County Erosion Control Plan Review Checklist and include all applicable construction details.
These can be found on the Chatham County Watershed Protection website. on the Erosion Control
weboagc. "Phis plan must satisfy all local, state, and federal minimum plan requirements.
General Plan: submit (1) copy of site plan showing proposed disturbance limits along with the Chatham
County Residential General Plan. Site plan is not required to be completed by a design professional. The
Residential General Plan can be found on the Chatham County Watershed Protection website.
Residential land -Disturbing Permit ► cbpage. Complete table on sheet 1 of Residential General Plan.
❑ Residential Lot Permit. The following items are required to obtain this permit: completed
application, site plan, and fee. Page 3 "Financial Responsibility/Ownership Form" not required.
FeeRequirements: Plan Requirements:
V00 flat fee Site Plant showing property boundaries and proposed disturbance limits. The site
elan reauired by the Environmental Health Department can be used as a base.
ALL CHECKS MADE PAYABLE TO CHATHAM COUNTY
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Cs tAT! iAM C_.CIUNTY
�[1K/// ■ ARf1l l\IA
Land -Disturbing
Permit Application
**The mailing and street address of the principal place of husiness for the person)'enIit► fin ancialh, responsible and
the land o►►ner(s) must be provided. A P.O. box is NOT acceptable as an addr"s.
xxIf the financialK responsible party is different from the current land owner. an agreement signed b► both parties
must be pro► ided alien in the financially responsible party to Conduct the land -disturbing activity on the prope rt..
This agreement i5 pro►ided on page 3 of this application sod mast be completed in its entireq.
PROJECT NAME: Cotett Landing SubdivWM DATE: September 8- 2022
ADDRESS OF PROJECT: 0 Old Grahare Road
LATITUDEILONGITUDE OF PROPERTY AT SITE ENTRANCE: 39.76N. 79.19W
PARCEL #(S): OW65W a 00'"' 5
TOTAL DISTURBED ACRES .r SQUARE FEET: 52.03 A&Mi
PURPOSE OF ACTIVITY: Gor&uctn or Reso< n Iai su"-slan
FEE AMOUNT SUBMITTED: $26,000 RIVER BASIN: CAPE FEAR
"LANDOWNERS OF RECORD attach page to list additional owners
Please provide a complete list of partners, managing members and registered agents if the responsible entity or
land owner is a group of individuals, corporate organization or entity.
Name: The: U*Xd Group. LTD Phone: [phone]
Address: 362 ktuntain tact E-Ma i t s forddap 4 m -
CNhpel HN• NC 27517 Signature: C4
** INANCIALLY RESPONSIBLE PARTY (applicable only if different from ro rt►- owner
Name: Regard Landing. LLC PhonC: [phone]
Address: 362 AAm ain Laurel E-Mail: kmklaPrilfton
Ct►apel Hie, NIC 27517 Signature:
NORTH CAROLINA AGENT a licable onl • if either owner I IV responsible art% does not
reside in North Carolina]
Name: Phone:
Address: E-Mail:
Signature:
ENGINEEWSURVEYOR
Company Name: 9 v"O" a:"y`9 PLc
Address: 137 Middtegreen Piave
HoDy Springs. NC 27540
Contact Person: Zak Shipman. PS
Phone. [phone]%
E-Mail: Z*0 hipma Wgineenng-cam
EROSION CONTROL
Person to contact should erosion & sediment
control issues arise during land -disturbing activity:
Contact Person: Fad D'Apnx
Company Name: The Rexford Group, LTD
Phone: [phone]
E-Mai I : �'OT"o boom y rRaC CG+' ►
Page 2 of 3
ANTICIPATED START DATE: Late 2022 ANTICPATlD END DATE: dude' 2023

Soil Erosion and Sedimentation Control
CtfA-rIHwm C i�ur�rt Y
P.�' ■ • �• • M ' *� Financial Responsibilinl()►►nership Form
NOT REQUIRED TO BE COMPLETED FOR RES1DEVTI4L LOT PERMITS.
PLEASE READ THE DQLLQWINQ INFORMATION:
1) This section must be signed in the presence of a %o(ary.
2) This form must be signed by the property o►►ncr if an individual. If ouvtd by a company or corporation. this form must be signed by an oWker_
director, parn►cr, attorney -in-fact_ or otter person with authority to execute instruments for the ,axp►ration and accompanied by a compk-W list of all
panmrs, managing members and rcgWcred agents of the company or wrporation.
31 Ibis form must also be signed b► the tinancW1% responsibk party and NC agent (if applicable)• Same Mvisitxts of * 2 above apply .
4 if the landowner and tnancialh responsible party are di1%rent_ the completion and %igning of this page shall sere as ikwumentxlson
ackrtuwledging the landowltcr consents to and authorizes the f inancialIN reslx►n ible party to undertake the pngx),sed land -disturbing activity on the
landowners mwt(sI of land identified on this application.
5) -1be information pnr► ided on this form is true and concct to the be>t of in, kwA ledge and hclirf and .►ac pro. Lded by me witik and r oath.
5) All Land -Disturbing permits are ►al id for up to (2) years from the date of issuance. if cimum%.wv-es ►.arrant_ the permit may be extended for
(2) ►cars per the conditions of the Chatham County Soil Erosion and Sedimentation Cotton Ordinance. L pon ►%rincn notice, the land -Disturbing
permit may be rc%ol ed for failum to comply with the ordinance. If the permit is re►oled, all other permits and approvals are Nithheld until
the property is once again in compliance. with Chatham County regulations. Also. upon written notice. a ci► it penalty (fine) can he instigated
Win%I the propem owner and -or additional financially responsible party (if aay ) for ► iolauons of the Chatham Counts Soil Erosion and
S.dimen tadon Control Ordinance. This penalty is up to T5000M per ►iolation per day and is assessed daily for c►ery day the pnipern is in ► iotation.
Interfcring with or hampering an inspw ion can result in a ci►iI penalty without written notice.
OWNER OF PROPERTY:
Name and
Company [
Si&mature:
FINANCIALLY RESPONSIBLE PARTY (applicable only if different front property owner):
Name and Title:
Company:
Signature -
NORTH CAROLINA AGENT (if any):
Name and Title:
Compam :
Signature:
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1. 1;ahAye, W _. a Notary Public of \.V/ok- _County in the state
of Borth aro II rlc� do hereby certify that t_personally
appeared before me this da% and under oath acknak'ledged reading the information above and acknoNledged that the
above form was executed by him or her.
Witness my hand and official seal, this the U day of Sepf "_. 20a;L.
:-k
Notar% Public _ NO I,
My commission expires �� (SEAL) r
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