NCC242276_FRO Submitted_20240726

City of Greensboro, NC
Grading Permit Application
GREENSSORO
Owner Information: Permit#:
Company HAK OF NC LLC Contact RANA HUMAYUN
Address 393 S.SWING RD Phone No. 336-579-9033
GREENSBORO,NC 27409-2009 Email [e-mail]
Project Information:
Project Name YOUNGS MILL RD-GAS STATION
Address 1730 YOUNGS MILL RD Latitude 36.035739 Longitude -79.697015
GREENSBORO.NC 27406 Tax Map
Area Graded 2.1 Acres and/or sq.ft. Site Area 2.02 Acres and/or sq.ft.
Proposed Use of Property CONVENIENCE STORE&RESTAURANT Zoning CD-C-M
Brief Description of Project Location PROJECT IS LOCATED TO THE NORTHWEST OF THE INTERSECTION OF YOUNGS MILL RD
AND LEE ST.LOCATED TO THE NORTH OF INTERSTATE 1-85.
Brief Description of Development Plan FUTURE PLANS ARE TO DEVELOP THIS SITE FOR CONVENIENCE STORE WITH GAS SALES
AND RESTAURANT USE.PROPOSED PLANS ARE FOR A GRADING PERMIT ONLY WITH THIS CURRENT SUBMITTAL.
If this application is approved by the properly designated authorities and a grading permit issued,the undersigned does hereby agree to
comply with all applicable City regulations under the Greensboro Soil Erosion and Sedimentation Control Ordinance as described in
Chapter 30-12-6 of the Greensboro Land Development Ordinance.
Before beginning any grading operation, call for an on-site pre-construction meetin when area has been protected,call for final
inspection.
Signature of owner,developer,or agent: Date: e2 169. f /2-q
FOR OFFICE USE
Approved by Date
Permit No. Date
Tracking No. Date Approved Tracking Type: TRC Grading
Surety Amount Surety Type: LOC SCB HOD Check
Surety Number Surety Expiration Date
Temporary Measures Approved Date
Final Inspection Approved Date
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CITY OF GREENSBORO
FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
SEDIMENTATION POLLUTION CONTROL ACT
No person may initiate any land-disturbing activity covered by the Sedimentation Pollution Control Act before this form
has been completed and filed with the Sediment and Erosion Control Section of the City of Greensboro. (Please type
or print and, if questions are not applicable, place N/A in the blank).
Part A:
1. Project Name: YOUNGS MILL RD GAS STATION
2. Location of land-disturbing activity: 1730 YOUNGS MILL RD,GREENSBORO,NC
3. Approximate date land disturbing activity will be commenced: MARCH 31ST,2024
4. Development type: Commercial v Industrial_Institutional MF residential SF residential
5. Approximate acreage of land to be disturbed: 2.1
6. Has an erosion and sediment control plan been filed? Yes v No
7. Landowner(s)of Record (attach pages to list additional owners):
HAK OF NC LLC-RANA HUMAYUN 336-579-9033 sscontractingnca(�gmail.coi
Name Telephone Email
393 S.SWING RD SAME
Current Mailing Address Current Physical Street Address
GREENSBORO NC 27406
City State Zip City State Zip
8. Deed County: GUILFORD Book: 8777 Page: 46
9. Person to contact should erosion and sediment control issues arise during land-disturbing activity:
Name: RANA HUMAYUN Telephone: [phone]
E-mail: [e-mail] Other:
Part B:
1. Company(ies)or firm(s)who are 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.
HAK OF NC LLC-RANA HUMAYUN 336-579-9033 sscontractingncRgmail.cos
Name Telephone Email
393 S.SWING RD SAME
Current Mailing Address Current Physical Street Address
GREENSBORO NC 27406
City State Zip City State Zip

2. (a) If the Financially Responsible Party is not a resident of North Carolina, give name and street address of the
designated North Carolina Agent:
Name Telephone Email
Current Mailing Address Current Physical Street Address
City State Zip City State Zip
(b) 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 name and street address of the Registered Agent:
Name Telephone Email
Current Mailing Address Current Physical Street Address
City State Zip City State Zip
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 the 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.
RANA HUMAYUN MEMBER
Type or print name Title or Authority
Signature Date
I, S,ii /-t Z1-Vb Av< B 12 , a Notary Public of the County of (.:2a
State of v��C>21 C .tea�1••��. , hereby certify that t4/0/ /717--1M4/6-4&)
Personally accepted before me this day and under oath acknowledged that the above form was
executed by owner(s).
Witness my hand and notarial seal, this �sd y of fr e , 20 -1 4/ .
My Commission expires Shahzad Akbar
No 1AKY PUBLIC
...e", t(k•-•-•7 •
Guilford County
North Carolina
My Commission Expires February 11,2026