NCC230356_FRO Submitted_20230209

OKnu:rownor' ENGINEERING DEPARTMENT
h011y 128 South Main Street - PO Box 8 Holly Springs, NC 27540
Springs [phone] • FAX [phone]
nOfl l"II C,A K01, IN
Application for Construction Drawing Plan Approval, Erosion & Sedimentation Control Plan Approval, NPDES Stormwater
Review, Land Disturbance Permit Issuance, and Statement of Ownership and Financial Responsibility:
(Check All That Apply)
F■ Construction Drawing Plan Review O Erosion & Sedimentation 0■ NPDES Stormwater Review
Control Plan Review
1. Project Name, Project ID, and Phase: South Main Office Phase:
2. Description of Construction/Land Disturbance:
14,400 SF office building with parking and utilities to service the building
3. Landowner(s) of Record: (Use additional pages if necessary and attach to application)
851 south main LLC
Name
315 N academy street, STE 201
Address
Cary, NC 27513
City, State, Zip
919-659-1802
Name
Address
City, State, Zip
Telephone Fax Telephone Fax
[e-mail]
Mobile Phone Email Address Mobile Phone Email Address
4. Future Landowner(s), If Applicable: (Use additional pages if necessary and attach to application)
Name Name
Address Address
City, State, Zip City, State, Zip
Telephone Fax Telephone Fax
Mobile Phone Email Address Mobile Phone Email Address
5. List Book & Page where Deed or Instrument is Filed in Wake County:
Location Description: 851 s. main Street
Parcel Identification Number (PIN): 0648987588 Tax Map, Block, and Lot Number:
Book: 017823 Page: 743 Book:
6. Person(s) or Firm(s) Financially Responsible for Land -Disturbing Activity
851 S. Main Street, LLC
Name Name
1120 SE Cary Pkwy, Suite 100
Address
Address
Page:
Cary, NC 27518
City, State, Zip City, State, Zip
919-573-4814
Telephone
Mobile Phone
9001
5/2/14
Fax Telephone
[e-mail]
Fax
Email Address Mobile Phone Email Address

Application for Construction Drawing Plan Approval, Erosion & Sedimentation Control Plan Approval, NPDES
Stormwater Review, Land Disturbance Permit Issuance, and Statement of Ownership and Financial Responsibility:
7. Registered Agent, if any, for Person(s) or Firm(s) Financially Responsible:
(NOTE: A North Carolina agent is required if the applicant is not a resident of North Carolina.)
Address
City, State, Zip
8. Plans Prepared By:
the Spaulding group
Name of Firm/Person
5318 burning oak ct
raleigh, nc 27606
City, State, Zip
9. Site/Project Information:
Telephone
Mobile Phone
Address
Telephone
919-669-1078
Mobile Phone
[e-mail]
Email Address
Fax
Total Size of Tract:
3.08
acres Area Disturbed: 2.01 acres ft2
Length of Sidewalk:
652
linear feet Length of Streets: n/a linear feet
Length of Water Line:
269
linear feet Length of Sewer Line: 194 linear feet
Length of Greenway:
n/a
Length of Stormwater: 976 linear feet
# Stormwater BMPs < 5 acres:
1 # Stormwater BMPs > 5 acres:
Latitude: 35 39 02
Longitude: 78 50 00
FEMA/FIRM Map #:
Panel #: Effective Date:
Total Post Development Impervious Surface: 0.95 acres Ft
10. Approximate Date Land Disturbance Will Begin: 4-1-22
11. Signature and Witness: The above information is true and correct to the best of my knowledge and
belief and w Fovided by me while under oath.
ignature of Perso Financially Responsible Type or Print am Legibly
Title or Authority Date
I, M T a Notary Public of the County of hereby certify
that viu'ca personally before me this day and under oath acknowledged that
this Application for Construction Drawing Plan Approval and Erosion & Sedimentation Control Plan Approval/Land
Disturbance Permit Statement of Ownership and Financial Responsibility was executed by him or her.
Witness my hand and notarial seal, this T'l' day of _ UG ( _, 20 2-2-
'Millirr
Signature of Notary Public My Commission Expires
o SE
y�
Notary Public -_
Johnston County
2
O �
CA Q 0�
5/2/14
FOR OFFICE USE ONLY
Date Completeness Verified:
Project Number: PN-
Fees Paid:
❑ Construction Drawing Review Fees
❑ Erosion & Sedimentation Control
Plan Review Fees