NCC232597_FRO Submitted_20230829

FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
SEDIMENTATION POLLUTION CONTROL ACT
No person may initiate any land-disturbing activity on one or more acres as covered by the Act before this form
and an acceptable erosion and sedimentation control plan have been completed and approved by the Land
Quality Section, N.C. Department of Environmental Quality. Submit the completed form to the appropriate
Regional Office. (Please type or print and, if the question is not applicable or the e-mail address or phone
number is unavailable, place N/A in the blank.)
Part A.
1. Project NameCONTRACT LUMBER EXPANSION
2. Location of land-disturbing activity: County LEE City or Township Jonesboro
Highway/Street Lee Ave Latitude(decimal degrees) 35.4433 Longitude(decima!degrees)-79.1399
3. Approximate date land-disturbing activity will commence:August 2023
4. Purpose of development(residential, commercial, industrial, institutional, etc.): Industrial
5. Total acreage disturbed or uncovered(including off-site borrow and waste areas):6.3 Ac
6. Amount of fee enclosed: $700.00 . The application fee of$100.00 per acre (rounded
up to the next acre) is assessed without a ceiling amount (Example: 8.10-acre application fee is$900).
Checks should be addressed to NCDEQ.
7. Has an erosion and sediment control plan been filed? Yes D Enclosed ❑x No ❑
8. Person to contact should erosion and sediment control issues arise during land-disturbing activity:
Name Troy Meikle E-mail Address [e-mail]
Phone: office# [phone] Mobile# [phone]
9. Landowner(s) of Record (attach accompanied page to list additional owners):
LINE DRIVE PROPERTIES SANFORD LLC [phone]
Name Phone: Office# Mobile#
3245 Hazleton-Etna Rd SW 3245 Hazleton-Etna Rd SW
Current Mailing Address Current Street Address
Pataskala, OH 43062 Pataskala, OH 43062
City State Zip City State Zip
10. Deed Book No. 1604 Page No.497 Provide a copy of the most current deed.

Part B.
1 Company(ies)who are financially responsible for the land-disturbing activity(Provide a comprehensive list
of all responsible parties on accompanied page.) If the company is a sole proprietorship or if the landowner(s)is
an individual(s), the name(s)of the owner(s)maybe listed as the financially responsible party(ies).
LINE DRIVE PROPERTIES SANFORD LLC [e-mail]
Company Name E-mail Address
3245 Hazleton-Etna Rd SW 3245 Hazleton-Etna Rd SW
Current Mailing Address Current Street Address
Pataskala, OH 43062 Pataskala, OH 43062
City State Zip City State Zip
Phone: Office# [phone] Mobile# [phone]
Note: If the Financially Responsible Party is not the owner of the land to be disturbed, include with this form
the landowner's signed and dated written consent for the applicant to submit a draft erosion and sedimentation
control plan and to conduct the anticipated land disturbing activity.
2. (a) If the Financially Responsible Party is a domestic company registered on the NC Secretary of State
business registry, give name and street address of the Registered Agent:
Not Applicable
Name of Registered Agent E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Phone: Office# Mobile#
Name of Individual to Contact(if Registered Agent is a company)
(b) If the Financially Responsible Party is not a resident of North Carolina, give name and street address
of the designated North Carolina agent who is registered on the NC Secretary of State business registry:
Corporation Service Company [e-mail]
Name of Registered Agent E-mail Address
2626 Glenwood Ave., Suite 550 2626 Glenwood Ave., Suite 550
Current Mailing Address Current Street Address
Raleigh, NC 27608 Raleigh, NC 27608
City State Zip City State Zip
Phone: Office# Mobile# [phone]
Troy Meikle
Name of Individual to Contact(if Registered Agent is a company)

(c) If the Financially Responsible Party is engaging in business under an assumed name, give name under
which the company is Doing Business As. If the Financially Responsible Party is an individual, General
Partnership, or other company not registered and doing business under an assumed name, attach a copy
of the Certificate of Assumed Name.
Not applicable
Company DBA Name
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(s)
or his attorney-in-fact, or if not an individual, by an officer, director, partner, or registered agent with
the authority to execute instruments for the Financially Responsible Party). I agree to provide
corrected information should there be any change in the information provided herein.
Troy Meikle t , N c% �!r------__
or print n:me
T Title or Authority
Signature Date l
I, n-, ei 1 L ' /k-M' , a Notary Public of the County of ; >C,C.iS}:2,
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State of North Carolina, hereby certify that /icy 'e f it AC appeared personally
before me this day and being duly sworn acknowledged that the above form was executed by him/her
Witness my hand and notarial seal, this 9 day of �u.ne_ , 20 4:773
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My commission expires "/G '''7 /
z DENEEN WELKER
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APPLICATION IDENTIFICATION N.C. DEPARTMENT OF TRANSPORTATION
Driveway Date of STREET AND DRIVEWAY ACCESS
Permit No. Application
PERMIT APPLICATION
County: LEE
Development Name: CONTRACT LUMBER EXPANSION
LOCATION OF PROPERTY-
Route/Road: SR 1133 - LEE AVENUE
Exact Distance 330 ❑ Miles N S E W
® Feet ® ❑ ❑ ❑
From the Intersection of Route No. SR 1136-Wilson Rd and Route No.sR 1133-Lee Ave Toward Cameron Dr
Property Will Be Used For: ❑ Residential/Subdivision El Commercial 0 Educational Facilities 0 TND 0 Emergency Services 0 Other
Proi)ert : El is ❑ is not within Sanford - City Zoning Area.
AGREEMENT
• I, the undersigned property owner, request access and permission to construct driveway(s) or street(s) on public right-
of-way at the above location.
• I agree to construct and maintain driveway(s) or street entrance(s) in absolute conformance with the current "Policy on
Street and Driveway Access to North Carolina Highways" as adopted by the North Carolina Department of
Transportation.
• I agree that no signs or objects will be placed on or over the public right-of-way other than those approved by NCDOT
• I agree that the driveway(s) or street(s)will be constructed as shown on the attached plans.
• I agree that that driveway(s) or street(s) as used in this agreement include any approach tapers, storage lanes or
speed change lanes as deemed necessary.
• I agree that if any future improvements to the roadway become necessary, the portion of driveway(s) or street(s)
located on public right-of-way will be considered the property of the North Carolina Department of Transportation, and I
will not be entitled to reimbursement or have any claim for present expenditures for driveway or street construction.
• I agree that this permit becomes void if construction of driveway(s) or street(s) is not completed within the time
specified by the "Policy on Street and Driveway Access to North Carolina Highways".
• I agree to pay a $50 construction inspection fee. Make checks payable to NCDOT. This fee will be reimbursed if
application is denied.
• I agree to construct and maintain the driveway(s) or street(s) in a safe manner so as not to interfere with or endanger
the public travel.
• I agree to provide during and following construction proper signs, signal lights, flaggers and other warning devices for
the protection of traffic in conformance with the current"Manual on Uniform Traffic Control Devices for Streets and
Highways" and Amendments or Supplements thereto. Information as to the above rules and regulations may be
obtained from the District Engineer.
• I agree to indemnify and save harmless the North Carolina Department of Transportation from all damages and claims
for damage that may arise by reason of this construction.
• I agree that the North Carolina Department of Transportation will assume no responsibility for any damages that may
be caused to such facilities, within the highway right-of-way limits, in carrying out its construction.
• I agree to provide a Performance and Indemnity Bond in the amount specified by the Division of Highways for any
construction proposed on the State Highway system.
• The granting of this permit is subject to the regulatory powers of the NC Department of Transportation as provided by
law and as set forth in the N.C. Policy on Driveways and shall not be construed as a contract access point.
• I agree that the entire cost of constructing and maintaining an approved private street or driveway access connection
and conditions of this permit will be borne by the property owner, the applicant, and their grantees, successors, and
assignees.
• I AGREE TO NOTIFY THE DISTRICT ENGINEER WHEN THE PROPOSED WORK BEGINS AND WHEN IT IS
COMPLETED.
2004-07 NOTE: Submit Four Copies of Application to Local District Engineer, N.C. Department of Transportation TEB 65-04rev.
61-03419

SIGNATURES OF APPLICANT
PROPERTY OWNER(APPLICANT) WITNESS
COMPANY LINE DRIVE PROPEIES SANFORD-Lke- - NAME Martha Bright _
SIGNATURE SIGNATURE
ADDRESS 3245 Hazleton-Etna Rd SW ADDRESS 2305 Carthage St.
Pataskala, OH 43062 Phone No. 614-774-6361 Sanford, NC 27330
AUTHORIZED AGENT WITNESS
COMPANY Meikle NAME Martha Bright
SIGNATURE _SIGNATURE
ADDRESS 4 a I -Etna Rd S ADDRESS 2305 Carthage St.
Pataskala, OH 43062 Phone No. 614-774-6361 Sanford, NC 27330
APPROVALS
APPLICATION RECEIVED BY DISTRICT ENGINEER
SIGNATURE DATE
APPLICATION APPROVED BY LOCAL GOVERNMENTAL AUTHORITY(when required)
SIGNATURE TITLE DATE
APPLICATION APPROVED BY NCDOT
SIGNATURE TITLE DATE
INSPECTION BY NCDOT
SIGNATURE TITLE DATE
COMMENTS:

SIGNATURES OF APPLICANT
PROPERTY OWNER(APPLICANT) WITNESS
COMPANY LINE—DRIVE PROPERTIES SANFORD LLC NAME Martha Bright
SIGNATURE U, _ SIGNATURE
ADDRESS 3245 Hazleton-Etna Rd SW ADDRESS 2305 Carthage St.
Pataskala,OH 43062 Phone No. 614-774-6361 Sanford, NC 27330
AUTHORIZED AGENT WITNESS
COMPANY TriOeikle NAME Martha Bright
SIGNATURE — - SIGNATURE
ADDRESS 3245 Hazl d SW Ai3DRESS—__ 2305 Carthage St.
Pataskala,OH 43062 _ Phone No. 614-774-6361 Sanford, NC 27330
APPROVALS-- -
APPLICATION RECEIVED BY DISTRICT ENGINEER
SIGNATURE DATE
APPLICATION APPROVED BY LOCAL GO\L RNMENTAL AUTHORITY(when required)
SIGNATURE TITLE DATE
APPLICATION APPROVED BY NCDOT
SIGNATURE TITLE DATE
INSPECTION BY NCDOT
SIGNATURE TITLE DATE
COMMENTS: