NCC232349_FRO Submitted_20230822

https://chathamcountync.viewpointcloud.com/categories/1082
Land-Disturbing
.1 1 v ��n� t ` ,� •, " Permit Application
Please include all required signatures. For Office Vie,
Physical Address Mailing Address
80 East St. PO Box 548
Pittsboro, NC 27312 Pittsboro, NC 27312
Phone: [phone]
Please see PERMITTING FLOW CHART to determine which permit, plan,and fee requirements
rpp v to your project and then check one of the boxes below:
Land-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 $1,000, and 2.01-3 is $1,500.
Plan Requirements:
Design Plan: submit(I) copy of an erosion control plan completed &sealed by a professional land
surveyor, 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
wcbLa&e. This 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 webpage. 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.
Fee Requirements: Plan Kc iuircments:
$100 Flat fee Site Plan showing property boundaries and proposed disturbance limits. The
l�luri required by the Environmental Health Department can be used as a base.
ALA.CHECKS MADE PAYABLE TO CHA'I'HAM COUNTY
Page 1 of 3

Land-Disturbing
C '1 I f\ t I I.% \.1 Cs( 1 IN I'1
" ' " " I Permit Application
**The mailing and street address of the principal place of business for the person/entity financially responsible and
the land owner(s) must be provided.A P.O. box is NOT acceptable as an address.
**If the financially responsible person/party is different from the current land owner,an agreement signed by both
parties must be provided allowing the financially responsible party to conduct the land-disturbing activity on the
property.
PROJECT NAME: n!enrrood.lia[Ites ChaneL9idge tat 180F _ DATE:
ADDRESS OF PROJECT: If t
LATITUDE/LONGITUDE OF PROPERTY AT SITE ENTRANCE: J$ 70 X1 ?? xszhg
PARCEL#(S): t'? /o
TOTAL DISTURBED ACRES or SQUARE FEET: .4
PURPOSE OF ACTIVITY: Build New Residential Home
FEE AMOUNT SUBMITTED: $100 RIVER BASIN:CAPE FEAR
**I,ANDO1h/Ni:1t(S) 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` _Woods Holdings LLC Phone: 2.1g$22.za94
Addres'oottiwany,rgaseorl3atatgtLNC„22Lit,1 E-Mail: [e-mail]
Signature:
**FINANCIALLY RESPONSIIRI.I_: PA It FY (applicable only IIdit'Icrcnt front property owner)
Name: Phone:
Address: E-Mail: — — —
-- ---- Signature:
NORTII CAROLINA AGENT (applicable onl if owner or financially responsible party does not reside in
North Carolina)
Name: Phone: •----_..
Address: . .-- E-Mail: .
-- — Signature: —
ENGINEER/SURVEYOR EROSION CONTROL
Company Name: sid.QntiaL.Ltlnsi_Spi_v es?LL -- ___.. ., Person to contact should erosion & sediment
Address: „i_91.7_,Evans-fld ..GatY..LV_27,.513 control issues arise during land-disturbing activity:
Contact Person: ..-Chad Kctapd___- --Contact Person: __ peal,Ah-Oo Company Name: Glenwood Homes _
Phone: - .9196596Z6l Phone:
9146.05:8502.__-____
E-Mali. _._sleari�s!snGGvru E: MailehadL'91t:nwavdhvtoes_cQuL.___- _....__
Page 2 of 3
vTICIPATED START DATE: 7/1/23 ANTICPATED END DATE: 0/31/24

Soil Erosion and Sedimentation Control
('I I/\111A C O1iNei 1
" """ ' ` Financial Responsibility/Ownership Form
NOT REQUIRED %O Bl s CONIPI,l '17s7) FOR RI;;$//3t N71,4.I:, 1,07'PL7RM1'/S,
PLEASE RE \I)TI-IL l OL.I.OWINc INFORMATION
1)This section mail be signed in the presence of it Notary
2)All I,rtnd-I)islurbing permits are valid Alf Up to (2) years ll'att the dine 01''smmtneu. II r;lietinkyInnees tti„riutt, llae petttltl liiill her
extcaxied for (2)years per the conditions of the Chatham County Nod Etosion and 'lethuire nttaitin Control tlltlin;ou;e l 1pt+u t%rivan
notice. the band-Disturbing permit may he rcvoheJ fur failure to comply wish the I)arlinintee. It IIr petuat is tel„toed, all (ober
Its rant: and approvals ;ate withheld mild the p rnpurty is once again in compliance with Chatham County rcltuhrlruns Akio, upon
turitten notice, a city)penally(line)can he ittstigrnerl attains) the property ooncr and/or atlditroactl linum...611y responsible pally(il`,rrt t
lilt t'to tilit,its uf'the Unitltam C-'nunlr Soil Erosion and Sedimentation Control t lydimince.This penalty is tip ill S ittl4tt.tllt per t iolttt i It
per day and is assessed daily for every day the properly is in t•icilntit+n. Interfering wittt ur hampering rm inspection eitti tes:rlt in;r viva
per ity tt•ithout ttritten notice.
3)The iii brltinliun prmicietl rna Ihis form is Iroe and correct to the best(I'ow kIuur ledge and belie!'and t as pros kied by me \thine
under oath,
4) 'Tins li,rua most be signed by Mu properly ot,ner Ivan intlit meal If owned by a enimpuny oret+Ilruralion,ibis loan inert be signed
Ilk' an officer. tlireelor, partner, attorney-itt•th e,, or other petsun with authority to cxccit e. insirulttoi for the corporation and
treeianptritted by a complete list Oran partnet's. managing inernbrts,Intl registered agents of the company or corporation.
OWNER OF PROPERTY:
Nantc and Title: Edwin Woods Manacling Member
Company (if applicnWo ' Woods Holdings LLC
Signature;
ADDITIONAL FINANCIALLY RESPONSIBLE PARTY (if any):
Name and Title:
Company:
Signature:
NORTH CAROLINA AGENT(itatiy):
Name and Title;
Company: .
Signature: ----
.**��e**y,k**************4****•�' **********************4*******tb********
L.e ill se Yet ereor- n Notary Public of_ l,l�(�t,
� :___County in the slate
of 00r4+) Ca.rO l•act.) clo hereby certify Mat i - +yibo C�•
appeared before Inc this day and under oath acknowledged reading the information above and acknowledged that the
above form was executed by him or her
Witness my hand and official seal, this the 1 day of HA•l. . 211AX
060,r!rtt.r'r'��,.
Notary Public avi �, •;
my Coln Illissioll cx1)iic5_-_-3 /a �..Q e _ ._ �'tfO ' '
PUBLIC
Page 3 of 3 ,'� . COUN1't•.`'.4+
.''ttrr,ri,tt.