NCC232174_FRO Submitted_20230721

nu:TOWN or ENGINEERING DEPARTMENT
ACHolly 128 South Main Street-PO Box 8 Holly Springs, NC 27540
Sprin s [phone] • FAX[phone]
N O I III C A H O I I N A
Application for Construction Drawing Plan Approval, Erosion &Sedimentation Control Plan Approval, NPDES Storm water
Review, Land Disturbance Permit Issuance, and Statement of Ownership and Financial Responsibility:
(Check All That Apply)
❑■ Construction Drawing Plan Review ❑■ Erosion&Sedimentation ❑ NPDES Stormwater Review
Control Plan Review
1. Project Name,Project ID, and Phase: Shoppes at Collins Park Phase:
2. Description of Construction/Land Disturbance:
Two commercial buildings with associated utilities and infrastructure within Collins Park
3. Landowner(s)of Record: (Use additional pages if necessary and attach to application)
Collins Park-Holly Springs, LLC
Name Name
246 Valleyfield Ln.
Address Address
Southern Pines, NC 28387
City, State,Zip City, State,Zip
Telephone Fax Telephone Fax
Mobile Phone Email Address Mobile Phone Email Address
4. Future Landowner(s),If Applicable: (Use additional pages if necessary and attach to application)
Unified Development Group, LLC
Name Name
9133 Fawn Hill Court
Address Address
Raleigh, NC 27617
City, State,Zip City, State,Zip
Telephone Fax Telephone Fax
[e-mail]
Mobile Phone Email Address Mobile Phone Email Address
5. List Book&Page where Deed or Instrument is Filed in Wake County:
Location Description: 100 Collins Rd.; LO3B Collins Park Lot 3
Parcel Identification Number(PIN): 0648959537 Tax Map, Block, and Lot Number: Lot 3
Book: 16060 Page: 689 ,•
Book: Page:
6. Person(s)or Firm(s) Financially Responsible for Land-Disturbing Activity
Unified Development Group, LLC
Name Name
9133 Fawn Hill Court
Address Address
Raleigh, NC 27617
City, State,Zip City, State,Zip
Telephone Fax Telephone Fax
[e-mail]
Mobile Phone Email Address Mobile Phone Email Address
9001
5/2/14

Application for Construction Drawing Plan Approval, Erosion &Sedimentation Control Plan Approval, NPDES
Storm water 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.)
Name Telephone Fax
Address Mobile Phone
City,State,Zip Email Address
8. Plans Prepared By:
Timmons Group/Robert Wingate 919-851-4591
Name of Firm/Person Telephone Fax
5410 Trinity Rd., Suite 102
Address Mobile Phone
Raleigh, NC 27616 [e-mail]
City,State,Zip Email Address
9. Site/Project Information:
Total Size of Tract: 4.14 acres Area Disturbed: 3.17 acres 138,114 ft2
Length of Sidewalk: 21 linear feet Length of Streets: N/A linear feet
Length of Water Line: 322 linear feet Length of Sewer Line: 70 linear feet
Length of Greenway: N/A Length of Stormwater: linear feet
#Stormwater BMPs < 5 acres: #Stormwater BMPs > 5 acres: N/A
Latitude: 35.63352 Longitude: -78.81513
FEMA/FIRM Map#: 3720064800J,3720065800J Panel#: 0648J; 0658J Effective Date: May 1, 2006
Total Post Development Impervious Surface: 89,900 Ft2
10.Approximate Date Land Disturbance Will Begin: 2022
11. Signature and Witness: The above information is true and correct to the best of my knowledge and
belief and was ro ided b me while under oath.
Vish Panjwani
Signature of Per on Financially Responsible Type or Print Name Legibly
owner 11/22/21
Title or Authority Date
I, W glte_c 1i\4 f , a Notary Public of the County of \Nape , hereby certify
that v,s1n PaA. w an, 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 andte notarial seal, this 22'"`� day of NIcve�wwbex , 20 2,
oP / I a q zoay
Signature of Notary4:1:f )My Commission Expires
FOR OFFICE USE ONLY
SE L. Date Completeness Verified:
WALKER CLAPP Project Number: PN-
NOTARY PUBLIC Fees Paid:
WAKE COUNTY, N.C. ❑ Construction Drawing Review Fees
My Commission(Expires 10-9-2024. ❑ Erosion &Sedimentation Control
Plan Review Fees
9001
5/2/14