NCC240954_FRO Submitted_20240417

Land-Disturbing
Cep A.in Permit Application
**The mailing and street address of the principal place of business for th person/entity financially responsible and
the land owner(s)must be provided.A P.O.box is NOT acceptable as an ddress.
**If the financially responsible party is different from the current land o ner,an agreement signed by both parties
must be provided allowing the financially responsible party to conduct th land-disturbing activity on the property.
This agreement is provided on page 3 of this application and must be co 'leted in its entirety.
PROJECT NAME: Ridgecrest Estates DATE: r2-20-23
ADDRESS OF PROJECT: 130 Manns Cha•-1 Road, Pittsboro, NC 7312
LATITUDE/LONGITUDE OF PROPERTY AT SITE ENTRANCE: 35.:047, -79.1556
PARCEL#(S): 1)1798,2) 1796
TOTAL DISTURBED ACRES or SQUARE FEET: 8.06 •
PURPOSE OF ACTIVITY: Subdivision
FEE AMOUNT SUBMITTED: $4,500 RIVER BAISIN:CAPE FEAR
"LANDOWNER(S)OF RECORD(attach page to list additional owner)
Please provide a complete list of partners,managing members and regis..ered agents if the responsible entity or
land owner is a group of individuals,corporate organization or entity.
Name: 1)Lovn Spoonful!,LLC;2)Efc Berg/Adrienne Foster Phone: 1)64 -2 55;2)919-619-7594
Address: 1)2 Tomac Ct;2)2458 Hamlets Chapel Rd E-Mail: 2)°mil )ed rfledisomfg.corn
1)Old Greenwich,Ct 06870;2)Pittsboro, NC 27312 Signatur!:
**FINANCIALLY RESPONSIBLE PARTY(applicable only f differelt from property owner)
Name: CORNERSTONE Devevelopment Services,LLC Phone: [phone]Eg
Address: PO Box 361(mail)2171 Sam Moss Hayes Rd(Phy) E-Mail: d c3dtsigne
Creedmoor,NC 27522 Signature.
NORTH CAROLINA AGENT(applicable only if either owner or finan4ially responsible party does not
reside in North Carolina)
Name: N/A Phone: N/A
Address: N/A E-Mail: N/A
N/A Signature:
ENGINEER/SURVEYOR t I I() •NT S L
Company Name: C3 Design&Engineering,PLLC Person to contact - ould erosion&sediment
Address: 2537 East Lyon Station Road control issues arise i;1 ring land-disturbing activity:
Contact Person: Cha E.Abbott, PE
Contact Person: Chad E. Abbott, PE Company Name: C3 i-sign& Engineering, PLLC
Phone:[phone] Phone: [phone] •
E-Mail: Chad©c3designeng.com E-Mail: chad •'c3d signeng.com
Page 2 of 3
ANTICIPATED START DATE: 10/1/2023 ANTICPATEI END DATE:06/01/2024

- ,i' Soil Erosion and Sedimentation Control
- Financial Responsibility/Ownership Form
NOT REQUIRED TO BE COMPLETED FOR RESIDEATL4L LOT PERMITS
PLEASE READ THE FOLLOWING NNFC MATION_
._ -•••. 71 This
ins mat be.signed in the presence of a Notary.
2) f>mti form must be signed by the property owner if an individual.If owned by a company or corporation,this form must be signed by
par ,attorney-in-fact,
—•
director, tner,a torney-in-fact,or other person with authority to execute instruments for the corporation and accompanied ns ofTt
pa tags,managing members and registered agent%of the company or corporation. Pain by a complete list o of f all
3)This form must also be signed by the financially responsible party and NC agent(if applicabt).Same provisions of 4 2 above apply.
4)If the landowner and financially responsible party are different,the completion and signing cif this page shall serve as documentation
acknowledging the landowner mosetrts to and authorizes the financially responsible party to wdertake the proposed land-disturbing activity on the
landowners trect(s)of land identified on this application.
3)The information provided on this form is true and correct to the best of my knowledge and b/lief and was provided by me while under oath.
6)All land-Disturbing permits are valid for up to(2)years from the date of issuance.If c r instances warrant,the permit may be extended for
(2)years per the conditions of the Chatham County Soil Erosion and Sedimentation Control Ordinance.Upon written notice,the lend-Dis urbing
permit may be revoked for failure to comply with the Ordinance. If the permit is revoker/all other permits and approvals are withheld until
..;:tea property is once again in compliance with Chatham County regulations. Alto,upon wri len notice,a civil penalty(fine)can be budgeted
• apihnt the propos),owner and/or additional financially responsible party(if any)for viol/Mongol the Chatham County Soil Erosion and
sa OaetKlsa Cantaol Ordinance.This penalty is up to$5000.00 per violation per day and is rt•red daily for every day the property is in violation.-
lhhe*rtsa with or hampering an inspection can result in a civil penalty without written notice.
OWNER OF PROPE'TY:
Name and Title: 1)I Spoonful!,LLC;2)Eric Berg I Adrienne Foster
•
Compeer(ifappl', , e): I)!Pin poonfuU,LLC
Sim; / nfjj
' h' ---
• ;;� �NCIALLY RESPONSIBLE PARTY(applicable only if different from property owner):
' !'*+ WriVe: Chad E.Abbott-President
--'
oimpny: O nt Services,LLC
Signature:
:.f`�+q" tl?itlitOLIINA AGENT((tinny):
.o. :NaYraadTitle:
Company:
Siglxttere:
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. *4a*#*.**********#****ale*..*****.*Anal.******eta#* **********************
>.D rd S l h( viJ ,a Notary Public of C.
Y7-A-U�1+//`1C,� County in the state
of OP r14 C — do hereby certify that `_ 4 r v�f personally
appeared before the this day and under oath acknowledged reading the information above and acknowledged thatthe
'e;f ,'- ovc form was executed by him or her.
.''•Wilnops my hand and official seal,this the y day of - ��l ,20�3 t i nuuwr,
,'1k: ' .2-`1(0 - , l)-2-2 (SEAL)
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