NCC242769_ESC Approval Submitted (3)_20240909

WWI TEL [phone]
FAX [phone]
WAKE Environmental Water Quality Division
COUNTY 336 Fayetteville Street•Raleigh,NC 27602
Services www.wakegov.com
Construction Plan Application for Sedimentation & Erosion Control
LAND DISTURBANCE—INDIVIDUAL LOT (S)
I.PROPERTY INFORMATION 1. Project Name: Co a.. i g 1 b€ 'o e_ T ( i
2. Address: (, L7-5 1-1 of se f) 1 IN.; I , WcAke, 7-c ,0,s.t._., L • 275 y?
3. Wake County Pin#: 0 5 1 D 3 G 3 4. Jurisdictional Area: Wb. K e (f;v 0 4 y
(Municipal Area or Wake County)
5. Zoning District attic.Wye, Fn.4
6. River Basin: AI U e (Meuse/Cape Fear)
7. County Watershed: Fc,11 s L a e,
(Falls Lake,Jordan Lake, Swift Creek, etc) use https://maps.raleighnc.gov/iMAPS/
8. Waterbody Index L7—It— (0, '1 )
(use NC Surface Water Classification Map https://ncdenr.maps.arcgis.com/apps/webappviewer/index.html)
9. Total project area in acres: itill 13.c s
10. Total area to be disturbed in acres: n 9 y
11. Present Land Use(Check): Non-residential Subdivision Agricultural Forest K Vacant
12. Recorded: Book of Maps No. 0`�j(ji 4 q Page No. 017 14 -©2 715
13. Property in Flood Zone: F /)
rrEMA/Flood Soils(circle) use https://maps.raleighnc.gov/iMAPSO
Lot Number(s) 2 V
15. Total Number of Lots 1
II. DOCUMENTS SUBMITTED TO PORTAL:
Copy of this application K„ Erosion Control Site Plans L (standard plan or custom plan)
Lot Plan IL (Recorded Plat or Plot Plan showing lots)
Checklist S&E Calculations IC Proof of Ownership/Consent Letter X
Signed and notarized Financial Responsibility/Ownership Form:

III. GENERAL INFORMATION
1. Property Owner(s) (specify the name of the corporation, individual, etc.,who owns the property):
Name: Cc,e 11 y 1�' r ut.9 e t
Street Address:
Mailing Address: L 22g Pt00 1 ; L P C:rcle , Rc.1eyt n1.0 • .Z 7 61k
E-Mail Address:
Phone#: Niel) 1.4 7 — 5 0 3 Cell#: ( ) Fax#: ( )
2. Applicant* (Person to whom all correspondence will be sent):
Name: VA g. W Cu S -o rt 6 u: 1;Ur S
Firm/other:
Street Address: 764 Moc'1 '4 l)a >>6 14�. E�yh -C 7 61
Mailing Address:
E-Mail Address: (or;ty h i' t 5.to^4
Phone#: ( ) Cell#: ( �i 14) g a , (i o 61 Fax#: ( )
Relationship to Owner: g,„ t jC r
*If not a resident of North Carolina, a North Carolina agent must be designated for the purpose of
receiving correspondences.
IV. APPLIICANT'S CERTIFICATIONU
PRINT NAME l G f P lr^(M M G!t U
SIGNATURE DATE 0 7 III 12r µ'
OWNER/PFyISbN FINANCIALLY RESPONSIBLE
V.FEES
Individual Lot Plan Review Fees qq
S&E Mnifee 0 B VI 3 x $250.00 = 0
Disturbed acres(to hundredth of acre) round to nearest dollar
Fees prorated
Individual Lot Permit Fees
S&E 0 `(Cj 3 x $250.00 =
Disturbed acres(to hundredth of acre) round to nearest dollar
Fees prorated
Fees—invoiced upon application
IF A LOT HAS A STREAM CROSSSING submit DWQ, 404 and/or 401 approval document
*For flood hazard soils or FEMA crossing, Flood Permit is required - apply to Permit Portal for
Flood Study Permit
Note: apply separately for building permit, well and septic through Permit Portal