NCC230246_FRO Submitted_20230127

Wr. A Slur) MUrAppai PA16dhVJ
t Single -Family Dwelling
VArff&J11 Salem. Nr 27101
IN�t�MS
Sop Field
PO Bux 2511
Erosion Control P e r m i t Application operations
lIku*)r sa+eM• r+c "l1102 2511
Please use this form when the Developer and Builder are not the same
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financially responsible party person and will be less than one (1) acre of
land disturbance on any one (1) lot.
Logs) to be Developed Information
Saleddress CA qY M C� �r
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Subdivision Name:G?�
Ant4pated Datcs of Corztruction ACI!Mly: Sta Ccmpletyan: L
— Gompiete the LC INFORMATION TABLE for each lot to be devaioped; ensure that the appropriate drainage pattern type is
denoted. Attach a corresponding, existing piatted surrey for each lot with your application, please. If not. your permit
application may not be accepted for review. '*'
Financially Responsibie Party Person
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IUlabilc Phone _ C Email Address. �' n ,Ii (.)I17(, he (� • C0)-J
My sic, lure hereto signifies I am Ilya ownentinandally responsitije party for job site mmpiianoe wilt? rho Emsion Ccrrtr:)l Ordinance
as outlined in Chap4er, Section 8.4 of the Unif6d De,&opmemt Ordinances (LIDO# of the City of Winston-SA&WFnrsyth County nr
Articie IV of She LIDO of the village of G: rnmons, Tr1wn e` LevAs iiie, or Town of %aikertown. I thereby acknowledge that the Best
1tan3gnrnyr,; Practicas arsr*tnfrsd on the at=hcd sketch plan must be properly installed and maintained to retain. sail 'r4t`'r) tt1P
=n5truc#ed lot.
1 -xr dersiand that 9 the total dsturbed area'ar any reason becomes greater than ore acre on any one (1) lot. a prnfessionaily designed
and sealed Erosion Control Plan will be required to be sutxnitted and approved l,efore file start of the Iand disturbrg activity on the lot. I
further acknowledge that City lr7spcction's stuff r1.ay rf1fuse to make building :rzpectorrs and the Erosion Contru Dvision may issue
Notices of Viidatim Stop 'rNtcrk C-cars ands r CMi Penalty Assessments far �dR; a to comply with Erosion Uniml requirerr-enis.
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arint %arrc cf Finap Ily : i l pcnsc 11ersorr
TO BE COhIP{LETED BY GTY STAFF ONLY:
Date of Appkation Submi,W
Permit Number
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5iF an lit s�xxisibie Person