NCC242029_FRO Submitted_20240709

G•L D S B C R• Planning Department
200 North Center Street
BE MORE DO MORE SEYMOUR Goldsboro, NC 27530
[phone]
Received Date:
Application Fee:$250(Includes advertisement fee) Initials:
SITE PLAN APPLICATION
For Office Use Only:
Application Number: Date processed:
Fee Type: ❑ Cash ❑Check # ❑ Credit Card initials:
Applicant Acknowledgement:
i understand that the City of Goldsboro must have three(3)sets of paper Site plans submitted along with an electronic site plan
emailed to the Planning Administrative Assistant listed on the website at www.qoldsboronc.qov/planninq or they will not be
able to send out my application for formal review.Application is not complete and will not be sent out for review until after the
City of Goldsboro acknowledges they have an electronic PDF copy of the required site plan along with the required paper copies
plus the Site Plan Application Fee. Once application is acknowledged as complete, I understand my review period will begin on
the identified date on the Departmental Review Schedule listed on the website. Information on the site plan shall meet or
exceed the City of Goldsboro Unified Development Ordinance(UDO). Site plan needs to be in sufficient detail and scale. See
attached sheet for common things expected on site plan.
Applicant Signature:
Property Address: N George St
Proposed Use: Commercial
Number of Employees/Shift: Days/Hours of Operation:
Outdoor Storage: 0 Yes 0 No Storage Type:
Total Acreage: 2.09 Frontage: 280' (On US 70) Depth: 278'
Wayne Co. Pin #: 2599990028, 2599990086, 2599991056, Current Zoning: GB & 1-2
2599991127, 2599991246
All businesses that operate within the city limits of Goldsboro must have a Business Registration certificate prior to opening a
business. Please contact the City of Goldsboro Inspections Department at 919-580-4385 for all necessary permits, including
ABC Permits, prior to operation or opening to the public. SEE ATTACHED FOR ADDITIONAL PIN #s & OWNER
Applicant (Print): Glandon Forest Equity. LLC
Applicant Address: 3825 Barrett Drive, Suite 100 City,State,Zip: Raleigh, NC 27609
Applicant Phone: [phone] Applicant Email: [e-mail]
Owner(Print): Jack H Edwards Trustees
Owner Address: 2002 E Mulberry St City,State,Zip: Goldsboro, NC 27530
Owner Phone: Owner Email:
(If owner differs from applicant a Owners Authorization Form is required upon submission)
SIGNATURE RE• .
eArAy
ie bAr ykt 5 I 1
Applicant-Prin ed Applicant r 113p-o
gnature Date
Rev.3 (4/18/2023)

SITE PLAN
A) One (1) copy of City of Goldsboro Site Plan application.
B) Applicable fees paid.
C) Six (6) copies of the site plan (not less than 11 inches by 17 inches sheet size,
with all pages stapled, at an appropriate scale) including, but not limited to, the
following information:
1. Title, date, north arrow, engineer's scale, graphic scale and the names and
addresses of developers and the persons or firms preparing the plan.
2. Vicinity sketch showing the site and its relationship to surrounding area.
3. Location and dimensions of property lines (bearings and distances), zoning,
setback lines, and all buildings (existing and proposed).
4. Property owner, lessee, length of lease for operation and proposed use(s).
Site plans requiring Planning Commission and City Council approval shall be
submitted within 14 days of the next regularly scheduled Planning
Commission meeting and shall also contain the following Certificate of
Ownership and Approval:
5. "I (We) hereby certify that I am (we are) the owner(s) of the property shown
and described hereon and that I (we) hereby approve this development plan.
I (We) further certify that all exterior improvements, including but not limited
to paving and landscaping, as shown on the site plan will be maintained in
accordance with this plan."
6. Hours of operation, number of employees, floor plan, and location of
freestanding signs.
7. Disclosure of high noise area and aircraft crash hazard area, where
applicable.
8. Location of adjoining properties (where appropriate), names and addresses
of owners or record and current zoning classifications.
9. Site data in tabular form including total acreage, number of residential units,
number of bedrooms, gross floor area of each building and/or addition,
building height and proposed uses.
10.Parking and loading: minimum number required, actual number provided,
location, dimensions including width of aisles and bays, angle of parking,
handicapped spaces and ramps, proposed paving detail, circulation patterns,
vehicular entrances/exits and private drives. Statement should be included
identifying number and type of deliveries expected per month including type
of vehicle used.
11.Location and dimension of existing and proposed water lines, taps and
valves, fire hydrants, sanitary sewer lines, storm sewer lines, and manholes.
12.Location of electrical utility lines, service connections, meters and poles.
Appendix A-10 06/07/2021

13.Location and dimensions of streets showing right-of-way, street name or road
number, sight distance triangle, curb and gutter and location and dimensions
of sidewalks, alleys, curb cuts and pedestrian ways where required.
14.Drainage plan including locations and dimensions of pipes, ditches,
topographic information, finished grades, yard drains, catch basins and curb
inlets.
15.Location and dimensions of gas lines, if applicable.
16.Location and dimensions of HVAC equipment, pads and other related
facilities and
17.methods of screening.
18.Location and dimensions of any required refuse collection container spaces
and a statement identifying the method and frequency of litter and refuse
collection and agency to be used.
19.Existing wooded areas, trees, marshes and any other conditions affecting the
site
20.including tree save areas and tree protection fencing.
21.Where planting or landscaping will be provided, show locations, sizes,
common names and number of proposed plants and trees. Required
landscaped areas shall be clearly identified in respect to location and
plantings.
22.Location and width of required bufferyards, building setbacks and riparian
buffers.
23.Nitrogen release calculations if in Neuse River Basin, if applicable.
24.Grading plan including limits of disturbance.
25.Location of 100-year floodplain and existing wetlands (if applicable).
26.Location of all easements that are on the property.
27.Height, location and intensity of luminary devices.
28.lsolux lighting plan, if required.
29.Proposed phases of development, if applicable.
30.Site plans for planned unit developments shall clearly identify all common
areas and provide actual square footage of such area.
31.Any other information considered relevant by the Planning, or Engineering, or
Public Utilities Departments, or the Inspections Division.
32.Building elevations and other architectural information as required.
33.Location of proposed and existing sidewalks.
34.Owner's Statement
35.Landscaping Maintenance Agreement.
Appendix A-11 06/07/2021

Check if this project is ARPA-funded El
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, including any
activity under a common plan of development of this size as covered by the NCG01 permit, 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 Name Dollar General Goldsboro
"If this project involves American Rescue Plan Act (ARPA) funds, list the Project Name below
under which you applied for funding through the Division of Water Infrastructure (DWI).
2. Location of land-disturbing activity: County_Wayne City or Township Goldsboro
N George St 35.392444 -77.996595
Highway/Street Latitude(decimal degrees) Longitude(dedmal degrees)
3, Approximate date land-disturbing activity will commence:
4. Purpose of development(residential, commercial, industrial, institutional, etc.):commercial
5. Total acreage disturbed or uncovered (including off-site borrow and waste areas):2.24
6. Amount of fee enclosed: $300.00 . 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 ❑ Enclosed ❑ No ❑
8. Person to contact should erosion and sediment control issues arise during land-disturbing activity:
Name George T Barnes, Jr E-mail Address [e-mail]
Phone: Office# 919.459.2601 Mobile# [phone]
9. Landowner(s)of Record (attach accompanied page to list additional owners):
Jack H. Edwards Trustees
Name Phone: Office# Mobile#
2002 E Mulberry St 2002 E Mulberry St
Current Mailing Address Current Street Address
Goldsboro, NC 27530-4135 Goldsboro, NC 27530-4135
City State Zip City State Zip
10. Deed Book No.3137 Page No.455 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)may be listed as the financially responsible party(ies).
Glandon Forest Equity, LLC [e-mail]
Company Name E-mail Address
3825 Barrett Drive, Suite 100 3825 Barrett Drive, Suite 100
Current Mailing Address Current Street Address
Raleigh, NC 27906-7221 Raleigh, NC 27906-7221
City State Zip City State Zip
Phone: Office# 919.459.2560 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:
Amy Biggers [e-mail]
Name of Registered Agent E-mail Address
3825 Barrett Drive, Suite 100 3825 Barrett Drive, Suite 100
Current Mailing Address Current Street Address
Raleigh, NC 27906-7221 Raleigh, NC 27906-7221
City State Zip City State Zip
2600459.
Phone: Office# 919. 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:
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)

(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.
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.
George T. Barnes Jr. Manager
Type or print n Title or Authori
,3 �3
Signature Date
I, 1 " AM , 1)\/1 O VV , a Notary Public of the County of VJ6(
State of North Carolina, hereby certify that a led 1 1SGKYLLJ Jr. appeared personally
before me this day and being duly sworn acknowed that the above form was executed by him/her.
Witness my hand and notarial seal, this // day of U('r •ixe- , 20 ?.3
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Seal �.,1
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Continued from Items 9 & 10 in Part A of the Financial Responsibility/Ownership Form for multiple
owners. Attach copies of this page as needed to list all landowners.
Landowner 2 of Record:
General Electric Company
Name Phone: Office# Mobile#
PO Box 4900, Dept 201 PO Box 4900,Dept 201
Current Mailing Address Current Street Address
Scottsdale, AZ 85261-4900 Scottsdale, AZ 85261-4900
City State Zip City State Zip
Deed Book No.225 Page No.3281 Provide a copy of the most current deed.
Landowner 3 of Record:
Name Phone: Office# Mobile#
Current Mailing Address Current Street Address
City State Zip City State Zip
Deed Book No. Page No. Provide a copy of the most current deed.
Landowner 4 of Record:
Name Phone: Office# Mobile#
Current Mailing Address Current Street Address
City State Zip City State Zip
Deed Book No. Page No. Provide a copy of the most current deed.
Landowner 5 of Record:
Name Phone: Office# Mobile#
Current Mailing Address Current Street Address
City State Zip City State Zip
Deed Book No. Page No. _ Provide a copy of the most current deed.

APPLICATION IDENTIFICATION N.C. DEPARTMENT OF TRANSPORTATION
Driveway Date of
Permit No, Application STREET AND DRIVEWAY ACCESS
County: Wayne County PERMIT APPLICATION
Development Name: Dollar General—Goldsboro
LOCATION OF PROPERTY:
Route/Road: SR 2062 (W Grantham St)
Exact Distance 210 LI Miles N S E W
® Feet DEED
From the Intersection of Route No. US 70 Business and Route No. SR 2602 Toward west
Property Will Be Used For: ❑ Residential/Subdivision El Commercial ❑ Educational Facilities ❑ TND ❑ Emergency Services ❑ Other
Property: ® is ❑ is not within Goldsboro 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

I
SIGNATURES OF APPLICANT
PROPEROWN (APPLICANT) .. , WITN SS
COMPANY Glandon I--ors ckil LLC NAME ( t 100
SIGNATURE SIGNATURE
ADDRESS 3825 Barr D 've, Suite 100 ADDRESS 382 arrett Drive, Suite 100
Raleigh, 27 09 Phone No. 9194592602 Raleigh, NC 27609
AUTHORIZED AGENT WITNESS
COMPANY NAME
SIGNATURE SIGNATURE
ADDRESS ADDRESS
Phone No.
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:

APPLICATION IDENTIFICATION N.C. DEPARTMENT OF TRANSPORTATION
Driveway Date of STREET AND DRIVEWAY ACCESS
Permit No. Application
County: Wayne County PERMIT APPLICATION
Development Name: Dollar General—Goldsboro
LOCATION OF PROPERTY:
Route/Road: US 70 Business (N George St.)
Exact Distance 220 ❑ Miles N S E W
® Feet ❑ ® ❑ ❑
From the Intersection of Route No. SR 2062 and Route No. US 70 Toward south
Property Will Be Used For: ❑ Residential/Subdivision El Commercial ❑ Educational Facilities ❑ MID ❑ Emergency Services ❑ Other
Property: ® is ❑ is not within Goldsboro 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.
• 1 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.
• 1 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".
• 1 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.
• 1 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) WIT ES wf
COMPANY Glendon ail_ • i , LLC NAME T(ff i VV
SIGNATURE .." SIGNATURE /�G�
ADDRESS 3825 Barr: iirive, Suite 100 ADDRESS 382 arrett Drive,Suite 100
Raleigh, 7609 Phone No. 9194592602 Raleigh, NC 27609
9
AUTHORIZED AGENT WITNESS
COMPANY NAME
SIGNATURE SIGNATURE
ADDRESS ADDRESS
Phone No.
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: