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HomeMy WebLinkAboutNCC230648_FRO Submitted_20230310coy, Pitt County 079P � Planning Department Development Services Building o 1717 W. 5th Street Greenville, North o Carolina 507834-1696 James F. Rhodes, AICP TeleFav (252)830-2576 DPector Financial Responsibility / Ownership Form Soil Erosion and Sedimentation Control Ordinance No person may initiate any land -disturbing activity on one or more contiguous acres as covered by the Act before this form and an acceptable erosion and sedimentation control plan have been completed and approved by the Pitt County Planning Department. (Please type or pant `and, if question is not applicable, place N/A in the blank.) Dart A. 1. Project Name Colonial Materials 2. Location of land -disturbing activity: County Pitt City or Township Greenville -,and Highway/Street_ Taylors Creek Drive 3. Approximate date land -disturbing activity will be commenced: 1/1 2023 _ 4. Purpose of development (residential, commercial, industrial, etc.): Gravel parking lot. 5. Approximate acreage of land to be disturbed or uncovered: 2 ac 6. Has an erosion and sedimentation control plan been filed? Yes X No 7. Person to contact should sedimentation control issues arise during land -disturbing activity: Name Adam Elliott Telephone 910-443-0689 Landowner(s) of Record (Use blank page to list additional owners): Nyquist Properties, LLC Name(s) Name(s) P.O. Box 642 Current mailing address Street address Greenville, NC 27835 City State Zip City State 9t. R,corded in Deed Book No. 8 4 8 Page No. 539 Mari B. Zip Person(s) or firm(s) who are financially responsible for this land -disturbing activity (Use the blank page to list additional persons or firms): Colonial Materials Inc. Name of person(s) or Firm(s) Name(s) 1037 Taylors Creek Drive Current mailing address Street Address Greenville.. NC 27834 City State Zip City State Zip 252-751-9230 Telephone Telephone 2. (a) If the Financially Responsible Parry is a Corporation, give name and street address of the Registered Agent. Adam Elliott Name(s) 1037 Tavlors Creek Drive _. Current mailing address Street Address Greenville, NC 27834 City State Zip City State Zip 910-443-0689 Telephone Telephone (b) If the Financially Responsible Party is a Partnership give the name and street address of each General Partner (Use blank page to list additional partners): Name(s) Name(s) Current mailing address Current mailing address City State Zip City State Zip Telephone Telephone 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/her attorney -in fact or if not an individual by an officer, director, partner, or registered agent with authority to execute instruments for the financially responsible person). I agree to provide corrected information should there be any change in the information provided herein. Adam liott Colonial Materials Area Manager or ri n e Title or Autl on Signature Date I, a Notary Public of the County of P er State of North Carolina, hereby certify t at P%Am r+n ill: —k- appeared personally before me this day and being duly sworn acknowledged that the above form wasexeedted by him. Witness my hand and notarial seal this IS day of b e-c ey4m . 20_ZA t'n L=Yzt � HEATHER M GADDY Notary Notary Public, North Carolina My commission expires Q--a O - AQ a1 PenderCounty My Commission Expires PROPERTY OWNER AUTHORIZATION For Land Quality Permit I, AW NId-'5 r certify that I own the property identified as Tax Parcel 4-0036.0088F, and thus give permission to _ Colonial Materials Inc. to develop the project as currently proposed. Signature Date: SS MOW a Notary Public for the State of 2*6 County of 1` fM tlav 0v*CV _, do hereby certify that personally appeared before me this _ - _ day of DdC�'�1' WwY , 20 Z. and acknowledge the due execution of the authorization. SEA4,a+++SA M�,,u,,. � s'sioy,Q• P� O. �G y, My commission expires 0