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HomeMy WebLinkAboutNCC241652_FRO Submitted_20240611 1'»r1c1_ eo Pitt County 7s. "t' • Planning Department I+ . ;�! Development Services Building '16 1717 W. 5th Street Greenville, North Carolina 27834-1696 James F.Rhodes,AICP Telephone: (252)902-3250 Director Fax: (252)830-2576 Financial Responsibility/Ownership Form Soil Erosion and Sedimentation Control Ordinance No person may initiate any land-disturbing activity on one or more contiguous acres as covered by the Act before this form and an acceptable erosion and sedimentation control plan have been completed and approved by the Pitt County Planning Department. (Please type or print and, if question is not applicable, place N/A in the blank,) Part A. 1. Project Name AMBROSE BAY SUBDIVISION 2, Location of land-disturbing activity: County Pitt City or Township WINTERVILLE , and Highway/Street FROG LEVEL Road 3. Approximate date land-disturbing activity will be commenced:MAY 15th,2024 4. Purpose of development(residential, commercial, industrial, etc.):Residential 5. Approximate acreage of land to be disturbed or uncovered: 6 6. Has an erosion and sedimentation control plan been filed? Yes ✓ No 7. Person to contact should sedimentation control issues arise during land-disturbing activity: Name Chad Grimes Telephone 252-717-1418 8. Landowner(s) of Record(Use blank page to list additional owners): Grimes Built Construction,LLC Name(s) Name(s) 1202A East Firetower Road Current mailing address Street address Greenville NC 27858 City State Zip City State Zip 9. Recorded in Deed Book No. 4459 Page No, 358 Part B. 1. Person(s) or firm(s) who are financially responsible for this land-disturbing activity (Use the blank page to list additional persons or firms): Grimes Built Construction,LLC Name of person(s)or Firm(s) Name(s) 1202A East Firetower Road Current mailing address Street Address Greenville NC 27858 City State Zip City State Zip 252-717-1418 Telephone Telephone 2. (a) If the Financially Responsible Party is a Corporation, give name and street address of the Registered Agent. Name(s) Current mailing address Street Address City State Zip City State Zip Telephone Telephone (b) If the Financially Responsible Party is a Partnership give the name and street address of each General Partner(Use blank page to list additional partners): Name(s) Name(s) Current mailing address Current mailing address City State Zip City State Zip Telephone Telephone 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/her 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 change in the information provided herein. Chad Grimes Manager Ty p tin me Title or Authority t -I` - Signature Date I, athOil`r1 f713� ,a Notary Pu l'c of the County of n 4 — State of North Carolina,hereby certifythat (� Q,d.ZARAfuli ) appeared personally before me this day an being duly sworn acknowledged that the above form was executed by him. Witness my hand and notarial seal this h day of. f "`"`" 20 24 / • N8 / `,`, O •- M ,/` NO my •,•+'atom,ek a Mycommission expires D JQ3/2O2Lo ��. , p I NOTARY • PUBLIC CO 1 N0�,:��`''� /i, i11111111\111