NCC242149_FRO Submitted_20240724

°°in'2,4„ Gaston County
R. AF . Gaston Natural Resources Department
r‘1.*: 4tr 1303 Dallas-Cherryville Hwy. Dallas, N.C. 28034 Telephone: [phone]
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� aitly44. Soil Erosion & Sedimentation Control
g Financial Responsibility/Ownership
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No person may initiate any land-disturbing activity on one (1) or more acres of property in all portions of
Gaston County, except for that property within the city limits of the incorporated municipalities of Gaston
County who have not adopted the Gaston County Soil Erosion & Sedimentation Control Ordinance,
before this form and an acceptable Soil Erosion & Sedimentation Control Plan have been completed and
approved by the Gaston County Natural Resources Department's staff.
(Please type or print and, if question is not applicable, place N/A in blank)
PART A:
1. Project Name Chespark Drive Industrial
2. Location of land-disturbing activity
City Gastonia Highway/Street Chespark Drive
Latitude 35.287852 Longitude -81228046
3. Approximate date land-disturbing activity will commence May 1, 2024
4. Purpose of development (residential, commercial, industrial, etc.) Industrial
5. Total acreage disturbed or uncovered (including off-site borrow and waste areas) 2.99
6. Amount of fee enclosed $1,200
7. Soil Erosion &Sedimentation Plan Filed? Yes Enclosed ✓ No
8. Landowner(s)of Record(Use blank page to list additional owners)
Daniel Fisher n/a
Name Name
1850 Chespark Drive, Unit E n,�a
Mailing Address Mailing Address
Gastonia NC 28052 n/a n/a n/a
City State Zip City State Zip
516-779-3892 n/a
Telephone Number Telephone Number
9. indicate Deed Book and Page where deed(s)or instrument(s)are recorded
Deed Book 5445 Page 23/8
Deed Book n!a Page
10. Tax Map No. 3536571182 Block Lot No.
Page 1

PART B:
1. Person(s)or firm(s)who are financially responsible for this land-disturbing activity.NOTE:if FRP is not the
Landowner of Record Part A:8., include with this form the landowner's signed and notarized written consent for the
applicant to submit a draft erosion and sedimentation control plan and to conduct the anticipated land disturbing
activity.
York-Char Properties, LLC Daniel Fisher
Name Contact Name for Inspection Reports
1850 Chespark Drive, Unit E eastcwl7@aol
Street and Mailing Address Email Address
Gastonia NC 28052 516-779-3892
City State Zip Telephone Number
516-779-3892 N/A
Telephone Number Fax Number
2. If the Financially Responsible Party is not a resident of North Carolina, give the name and street
address of a North Carolina agent.
n/a
Name
n/a n/a
Street and Mailing Address Email Address
n/a n/a n/a n/a
City State Zip Telephone Number
3. If the Financially Responsible Party is a Partnership or other person engaging in business under
an assumed name, attach a copy of the certificate of assumed name. If the Financially
Responsible Party is a corporation, give the name and street address of the Registered Agent.
n/a
Name
n/a n/a
Street and Mailing Address Email Address
n/a n'a n/a n/a
City State Zip Telephone Number
4. 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 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.
2)4I\le E L ;srf�, f��-'✓4G>
Type or Print _ Title or Authority
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Signature Date tt
I, J ^��� , a Notary Public of the County of ;^1 ZcK(;?�� '�'' State of North
Carolina, hereby certify that = a r `I'vf— appeared personally beeefore me this day
and being duly sworn acknowledged that the above form was executed by him.
Witness my hand and notarial seal,this `T day of ,Marc!-. ,2 0 . /
Notary SEAL My Commission Ex ires
SCOTT D. O'CONNOR
NOTARY PUBLIC
Mecklenburg County Page
North Carolina
My Commission Expires December 9,2024