NCC233636_FRO Submitted_20231208

PLAN REVIEW/FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
CATAWBA COUNTY CODE OF ORDINANCES, CHAPTER 16 ARTICLE V
SOIL EROSION AND SEDIMENTATION CONTROL
No person may initiate any land-disturbing activity on one or more acres as covered by the Ordinance before this form
and an acceptable erosion and sedimentation control plan have been completed and approved by the Catawba County
Utilities and Engineering Department. (Please type or print, and if question is not applicable,please N/A in the blank)
PART A
1. Job Name (TIDAL WAVE AUTO SPA
2. PIN or 911 Address 1371219500671
3. Purpose of development(residential, commercial, industrial, institutional,etc.)[COMMERCIAL
4.Approximate soil disturbance date (December 16th,2023
5. Total acreage disturbed or uncovered(including off-site borrow and waste areas) 11.56 AC
6. Has an erosion and sedimentation control been filed? r Yes r No I Attached
7. If you have an Erosion Control billing account,would you like this to be billed? r Yes r No
Account Number
PEOPLE
8. Person to contact should erosion and sediment control issues arise during land-disturbing activity
Name IMARTIE MURPHY E-mail address [e-mail]
Telephone [phone] Cell# I706-647-0414 Fax# I
9. Landowner(s) of Record (attach accompanied page to list additional owners)
Name[VP JACKSONVILLE, LLC Telephone Fax# [
Current Mailing Address IPO BOX 812
City IWILKSBORO State NORTH CAROLINA Zip [28697
Current Street Address I
City State I Zip I
10.Deed Book No. 13438 Page No. 1465
PART B
1. Person(s) or firm(s)who are financially responsible for the land-disturbing activity (Provide a comprehensive list
of all responsible parties on attached sheet):
Name ITWAS PROPERTIES LLC E-mail address [e-mail]
Current Mailing Address 124 EAST THOMPSON STREET,PO BOX 311 [30286
City ITHOMASTON State [GEORGIA Zip

Current Street Address 1124 EASTTHOMPSON STREET,PO 311
City frHOMASTON State IGEORGIA Zip 130286
Telephone [phone] Fax# I
2. (a)If the financially responsible party is not a resident of North Carolina, give name and street address of the
designated North Carolina Agent:
Name ICT CORPERATION SYSTEM E-mail address
Current Mailing Address 1160 MINE LAKE CT,STE 200
City IRALEIGH State NORTH CAROLINA Zip 127615
Current Street Address 1160 MINE LAKE CT,STE 200
City RALEIGH State NORTH CAROLINA Zip 127615
Telephone I Fax#
2. (b)If the financially responsible party is a Partnership or other person engaging in business under assumed name,
attach a copy of the Certificate of Assumed Name. If the financially responsible party is a Corporation, give name
and street address of the Registered Agent:
Name E-mail address I
Current Mailing Address
City State Zip I
Current Street Address
City State I Zip I
Telephone Fax#
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 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 person). I agree to
provide corrected information should there be any change in the information provided herein.
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Type or Pri a e Title of Authority
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Signature Date
I, C ttr otyc(D.,r-1o,,,,. _ k„.4,a Notary Public of the County of Mer-L,Irk-J�..r,- State of North
Carolina,hereby certify tliat Mae} c. t plt1 appeared personally befo4me this day and being duly
sworn acknowledge that the above form was executed by h}n.
Witness my hand and notary seal,this Si> ' day of . -‘e_ ,20//3.
Seal
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April 11, 2026 Print Form