NCC242311_FRO Submitted_20240730

DocuSign Envelope ID:C714D0C3-F594-47E5-9008-051162AD910A
For TOWF Use Only Application #:
Project Name:
Date Received: Acres:
Date Approved: Fees Paid:
N TOWN of
WAKE FOREST
4
LAND DISTURBING (E&SC)
PERMIT APPLICATION, PLAN CHECKLIST, &
FINANCIALLY RESPONSIBLE OWNER (FRO) FORM
NO PERSON MAY INITIATE ANY LAND-DISTURBING ACTIVITY ON 1/2 ACRE OR MORE BEFORE THESE FORMS, FEES,AND AN
EROSION AND SEDIMENTATION CONTROL PLAN SEALED BY A NORTH CAROLINA REGISTERED PROFESSIONAL ENGINEER OR
LANDSCAPE ARCHITECT HAVE BEEN COMPLETED AND APPROVED BY THE TOWN OF WAKE FOREST. MULTIPLE SINGLE
FAMILY LOTS THAT DISTURB MORE THAN 1/2 ACRE ALSO REQUIRE A PERMIT AND SHALL FOLLOW THE STANDARD
PROCEDURES OUTLINED BELOW. SEE THE UNIFIED DEVELOPMENT ORDINANCE FOR ADDITIONAL INFORMATION AND FULL
ORDINANCE REGULATIONS.
NOTE: THE APPLICATION FEE OF$500.00 PER ACRE(ROUNDED UP TO THE NEXT ACRE I.E.:1.1 ACRES = 2 ACRES*
$500=$1,000)IS DUE AT TIME OF SUBMITTAL. IF FEES ARE NOT SUBMITTED THE PLAN WILL AUTOMATICALLY BE
DISAPPROVED.
DISCLAIMER:TOWN OF WAKE FOREST FEES AND CHARGES ARE SUBJECT TO CHANGE WITHOUT NOTICE.
PLEASE CALL 919-435-9443 TO CONFIRM CURRENT FEES AND CHARGES.
PART A: PROJECT INFORMATION
PROJECT NAME Wake Forest Self Storage Construction Plans
1. TAX PIN NUMBER 1850066925
2. ZONING HB-CU
1950 Friendship Chapel Rd
3. LOCATION/ADDRESS OF TRACT

DocuSign Envelope ID:C714D0C3-F594-47E5-9008-051162AD910A
4. SUBDIVISION N/A for# N/A
5. DEED BOOK 015832 PAGE 01913
*PLEASE PROVIDE A COPY OF THE MOST CURRENT DEED
6. PURPOSE OF DEVELOPMENT Storage Self Service
7. TOTAL NUMBER OF UNITS N/A
8. PERCENT IMPERVIOUS SURFACE 38%
9. TOTAL TRACT ACREAGE: 2.64 Acres
10. TOTAL ACREAGE DISTURBED (INCLUDING OFF-SITE UTILITIES AND ROADWORK): 1.8 acres
11. AMOUNT OF FEE ENCLOSED:
ROUNDED UP ACREAGE 2 * $500/ACRE = $ $1000
CHECK NUMBER
DATE PAID
DISCLAIMER:Town of Wake Forest fees and charges are subject to change without notice. Please call 919-435-
9443 to confirm current fees and charges.
12. PROPERTY OWNER(S) (PROVIDE LIST OF ADDITIONAL PROPERTY OWNERS ON AN ATTACHED SHEET):
NAME Andrew Ammons E-MAIL [e-mail]
ADDRESS PO BOX 97487 RALEIGH NC 27624-7487
PHONE [phone] CELL
13. PERSON TO CONTACT SHOULD EROSION AND SEDIMENT CONTROL ISSUES ARISE DURING LAND-DISTURBING ACTIVITY:
NAME Ryan Derrick E-MAIL
ADDRESS 1200 East Morehead, Suite 280 I Charlotte, NC 28204
PHONE [phone] CELL

DocuSign Envelope ID:C714D0C3-F594-47E5-9008-051162AD910A
14. PLANS PREPARED BY Amber Mason
ADDRESS 137 S Wilmington St. #200, Raleigh NC 27601
EMAIL [e-mail]
PHONE [phone] CELL 919.238.0311
15. DOCUMENTS SUBMITTED (SUBMITTER TO PLACE A CHECK MARK IN THE BOX):
FEES ($500 per acre rounded up, due upon 1st review) x
FINANCIAL RESPONSIBILITY OWNER FORM x
COMPLETED PLAN CHECKLIST x
PLANS (to be submitted with construction set) x
E&SC CALCULATIONS (1 copy) N/A
STORM WATER CALCULATIONS (1 copy) x
MAINTENANCE AND OPERATION AGREEMENT At later date
NCDOT Encroachment/Driveway Permit At later date
DWQ 401 Permit N/A
USACOE 404 Permit N/A
NCG010000 Permit COC At later date
EROSION & SEDIMENT CONTROL SURETY At later date
Spring 2024
APPROXIMATE DATE LAND-DISTURBING ACTIVITY WILL COMMENCE:
THE SOIL EROSION AND SEDIMENTATION CONTROL PLAN, supporting documents, maps and
computations submitted for the above tract conform to the requirements of all applicable
sections of the Town of Wake Forest Erosion & Sedimentation Control Ordinance outlined in
the UDO.
DocuSigned by:
I
� Project Manager 5/6/2024
12E70CCE2089408_..
SIGNATURE TITLE DATE

DocuSign Envelope ID: D8A45A7A-CF9B-447U-AO3F-1 FFB3C47B51 F
PART B. FINANCIALLY RESPONSIBLE OWNER (FRO)/PERSONS INFORMATION
1. PERSON(S)OR FIRMS WHO ARE FINANCIALLY RESPONSIBLE FOR THE LAND-DISTURBING ACTIVITY(PROVIDE A
COMPREHENSIVE LIST OF ALL RESPONSIBLE PARTIES ON AN ATTACHED SHEET):
Ryan Downs rdowns©smithpointcap.com
NAME EMAIL
1200 East Morehead, Suite 280
ADDRESS
Charlotte, NC 28204
CITY STATE ZIP CODE
706.424.2244
PHONE CELL
2. IF THE FINANCIALLY RESPONSIBLE PARTY IS NOT A RESIDENT OF NORTH CAROLINA, GIVE NAME AND STREET ADDRESS OF
THE DESIGNATED NORTH CAROLINA AGENT:
NAME EMAIL
ADDRESS
CITY STATE ZIP CODE
PHONE CELL -
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 OF REGISTERED AGENT E-MAIL ADDRESS
ADDRESS
CITY STATE ZIP

DocuSign Envelope ID: D8A45A7A-GF9B-4470-A03F-1FFB3G47B51F
PHONE FAX
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.
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NAME TITLE OR AUTHORITY
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SIGITURE DATE
1, , a Notary Public of the County of
, State of North Carolina, hereby certify that
appeared personally before me this day and being
duly sworn acknowledged that the above form was executed by him.
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Witness my hand and notarial seal, this o(L)- day of 6ep L P_CYIG;;-20 �.
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Additional Responsible Parties for FRO:
Hunter Dawkins
1200 East Morehead,Suite 280 I Charlotte, NC 28204
[e-mail] 1704-281-8959