NCC240416_FRO Submitted_20240220

1
G4goN coot' JACKSON COUNTY PERMITTING & CODE ENFORCEMENT
�Q Ah Lrnrd Distrn bance: One-Half(1/2) a arorc'Acres/Slorvrnt�aler Irrslallrrtion
', l�ina►rcial Respo►rsibiliip/O►v►rership Form
�lir Srira Office: 538 Scotts Creek Rd,Suite 205,Phone: [phone]/Fax: [phone]
%CA O' Cashiers Office: 357 Frank Alden Road,Phone: [phone]/Fax•: 828-745-6867
No person may initiate a land-disturbing activity and/or stormwater installation before this form has been completed and
an acceptable erosion and sedimentation control/stormwater plan has been approved by the Jackson County Office of
Permitting&Code Enforcement. If work is started without an approved permit your permit fcc will be doubled.
• Please type or print,and if any question is not applicable place N/A in the blank.
• Submit three(3)copies of the plan,a narrative,and the appropriate fee;please contact our office for
an accurate fcc calculation before submitting paperwork. For fee calculation call 828-745-6850 or e-
mail tiffanyquallst jacksonnc.org or jamicbaurngarncr�)jacksonne.org.
• A surety bond is required for any disturbance of five(5) acres or mote
Part A
1. Project Name: BEDROCK FILL SITE PIN 7642-42-9496,7642-52-1692
2. Location of land-disturbing activity/stormwater installation: (City or Township) SYLVA CITY ,
Highway/Street CHIPPER CURVE RD Latitude 32°23'13.3983"N Longitude 83°12'41.5413"W
3. This project will require the review of the following:n✓ Erosion Control n Stormwater
Is this project within a regulated district?[No l✓l Yes—District: SYLVA
4. Approximate date work will begin onsitc: STARTED;REVISED PLAN SUBMITTED
5. Purpose of development(residential,commercial,industrial,etc.) COMMERCIAL
6. Total acreage disturbed or uncovered (including off-site borrow and waste areas) 2.77 AC
7. Amount of fee$650-$300 PD=$350 FOR OFFICE USE:Received?(initial/date) T C o i a ' `1'
8. Has an erosion&sedimentation control/stormwater plan been filed?EINo ZYes Enclosed .
9. Person to contact should issues arise during land-disturbing activity/stormwater installation:
Name WAYNE SMITH E-mail Address [e-mail]
Phone Cell 828-269-0253 Fax ,
10. Landowners(s)of Record (Use blank page to list additional owners)Deck Bk/Pg arnctwn,2toatzvs (Provide a copy)
Name BEDROCK RENTALS,LLC Phone [phone] Fax
Current Mailing Address PO BOX 1905/SYLVA NC/28779
Part B
Company(ies)or firm(s)who arc financially responsible for the land-disturbing activity(Provide a
comprehensive list of all responsible parties on an attached sheet.) If the company or firm is a sole proprietorship,
the name of the owner or manager may be listed as the financially responsible party. 1 i 0 ed
BEDROCK RENTALS.LLC/WAYNE SMI'I'FI JACICOFSYLVA([7AOL.COM . -1 Cifr
Name 1;.-1-nail Address PO BOX 1905 v 22
' / 15
\hailing Address Street Address '
SYLVA NC 28779
City State Zip Code City State Zip Code RECEIVED
828-269-0253 F E B 1 2 102.4
Phone Number Fax Number
Note: if the Financially Responsible Party is not the owner oldie land to be disturbed,include with this form the landowner's signed and dated
written consent fur the applicant to submit a draft erosion and sedimentation control plan and to conduct the anticipated land disturbing activity.

1. (a) If the Financially Responsible Party is not a resident of North Carolina,please give name and street
address of a North Carolina Agent.
Name E-mail Address
Mailing Address Street Address
City State Zip Code City State Zip Code
Phone Fax Number
(b)If the Financial Responsible Patty is a Partnership or other person engaging in business under an
assumed name, attach a copy of the Certificate of Assumed Name. If the Financial Responsible
Party is a Corporation,give name and street address of the Registered Agent.
Name of Registered Agent E-mail Address
Mailing Address Street Address
City State Zip Code City State Zip Code
Phone Fax Number
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 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 authority to execute
instruments for the Financially Responsible Person). I agree to provide corrected information should there
be any changes in the information provided herein.
WAYNE SMITH MANAGER
yp or Print Name Title or Authority
,L.----1._ 1 -•\?5L-t
Signature Date
I,�MONTIVKAA-.0,-S a Notary ublic of t] Count}' of 't'��'S t3"
State of North Carolina, hereby certify that v V
t (/fit. appeared personally
before me this day and being duly sworn acknowledged that the above form was executed by them.
Witness my hand and notarial seal,this 1- d, o V `91,00,11,- ,20 91.1.
ounitimiiiiii
co J+ ; Notary
Notarwgypllc
Jackson __ My Commission F.xpiresMy Commission Expires July 1, 2028
County
/',, ,•mCA�nO\`‘``,

• File an Annual Report/Amend an Annual Report • Upload a PDF Filing • Order a Document Online •
Add Entity to My Email Notification List • View Filings • Print a Pre-Populated Annual Report form • Print
an Amended a Annual Report form
Limited Liability Company
Legal Name
Bedrock Rentals, LLC
Information
Sosld: 1350858
• Status: Current-Active O
Date Formed: 12/5/2013
Citizenship: Domestic
Annual Report Due Date: April 15th
CurrentAnnual Report Status:
Registered Agent: Smith, Michele D.
Addresses
Reg Office Mailing Principal Office Reg Mailing
240 Skyland Drive 51 Bridge Street 51 Bridge Street PO Box 1905
Sylva, NC 28779 Sylva, NC 28779 Sylva, NC 28779 Sylva, NC 28779
Company Officials
All LLCs are managed by their managers pursuant to N.C.G.S. 57D-3-20.
Manager
Wayne Smith
51 Bridge Street
Sylva NC 28779