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HomeMy WebLinkAboutNCC221939_FRO Submitted_20220523PLAN REVIEW/FINANCIAL RESPONSIBILITY/OWNERSHIP FORM CATAWBA COUNTY CODE OF ORDINANCES, CHAPTER 16 ARTICLE V SOIL EROSION AND SEDIMENTATION CONTROL No person may initiate any land -disturbing activity on one or more acres as covered by the Ordinance before this form and an acceptable erosion and sedimentation control plan have been completed and approved by the Catawba County Utilities and Engineering Department. (Please type or print, and if question is not applicable, please N/A in the blank) PART A I . Job Name Dollar General -Claremont, NC 2. PIN or 911 Address 1376009261827, 376009271032 & portion of 376009169901 3. Purpose of development (residential, commercial, industrial, institutional,etc.) Commercial 4. Approximate soil disturbance dater June 2022 5. Total acreage disturbed or uncovered (including off -site borrow and waste areas) 2.45 acres 6. Has an erosion and sedimentation control been filed? F Yes F No FX Attached 7. If you have an Erosion Control billing account, would you like this to be billed? Yes , No Account Number F PEOPLE 8. Person to contact should erosion and sediment control issues arise during land -disturbing activity Name Joe Strickland E-mail address jstrickland@teramore.net Telephone Cell # (704) 224-7364 Fax # 1 9. Landowner(s) of Record (attach accompanied page to list additional owners) Name Gary Michael Huffman Telephone Fax # Current Mailing Address [4972 Elmore Drive City [Catawba State NC Zip F28609 Current Street Address 4972 Elmore Drive City [Catawba State NC Zip 28609 10. Deed Book No. 3213/1708 Page No. 0761/0418 PART B 1. Person(s) or firm(s) who are financially responsible for the land -disturbing activity (Provide a comprehensive list of all responsible parties on attached sheet): Name FTeramore Construction, LLC Current Mailing Address 1214 Klumac Road -Suite 101 E-mail address jstrickland@teramore.net City Sallsbury State NC Zip 28144 9. Landowner(s) of Record (attach accompanied page to list additional owners) Name James Steven Turner Telephone Fax # Current Mailing Address 447 Frank Edwards Road City West Jefferson State INC Current Street Address 447 Frank Edwards City WestJefferson State �NC 10. Deed Book No. 1708 Page No. 1418 Zip 28694 Zip 128694 Current Street Address 214 Klumac Road - Suite 101 City Salisbury State NC Zip 28144 Telephone (704) 224-7364 Fax # 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 F_ E-mail address ^ T Current Mailing Address City I State F_ Current Street Address City r State r Telephone Fax # Zip Zip I 2. (b) If the financially responsible party is a Partnership or other person engaging in business under 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 � Current Mailing Address City Current Street Address F City E-mail address �� r State State I— Telephone � Fax # Zip 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 istered agent with the authority to execute instruments for the financially responsible person). I agree to provide correcte i ormation should there be any change in the information provided herein. Joe Stricklan - eramore Constructlon Manager Type or Pr' ame W Title of Authority 1�z y Sig u Date I, _ 1 I✓ �- %� . �! L Mr¢ViV a Notary Public of the County of I2 0 ln14 M G 4 V Atr 7 State of North Carolina, hereby certify that appeared personally before me this day and being duly sworn acknowledge that the above form was executed by him. Witness my hand and notary seal, this I�tTH day of F rz3 fZV-4-Z 7 20 DAN IEL R AI..MAZAN Se NOTARY PUBLIC . Rowan County Notary Norge Carolina 5 uNr My Commission Expires June 25J2022 My Commission expires Print Form Office: 828-465-8161 PO Box 389 Fax: 828-465-8392 Newton, NC 28658 www.catawbacountync.gov pW catawba county utilities & engineering Application for Erosion Control Permit PROJECT NAME: Dollar General - Clare rlont_ _ SOIL DISTURBANCE DATE: PROPERTY LOCATION (Property ID #): 376009261827, 376009271032 & portion of 376009169901 PHYSICAL STREET ADDRESS: TBD NC Hwy 10 PHYSICAL DIRECTIONS TO JOB SITE: Approx. 500' from the intersection of NC Hwy 10 & SR 1801 FINANCIALLY RESPONSIBLE PARTY (Name): _ Teramore Construction. LLC, Address: 214 Klumac Street - Suite 101 Salisbury NC 28144 704-224-7364 city State Zip Phone: Email address: istrickland@teramore.net CONTRACTOR NAME: Teramore Construction,,LLC Address: 214 Klumac Street - Suite 101 Salisbury NC 28144 Phone: 704-224-7364 City State Zip Erosion Control Account # Number of acres disturbed: 2.45 Type of Use: ( ) Accessory (} Assembly , Business (} Condominium O Institutional () Multi -Family Residential (} Residential Townhouse O Subdivision Type of Work: O Additions (} Roadway Construction Puroose of Development: (' ;ommercial () Residential Signatu (} Education O Mercantile O Other/ See Description (} Single Family Residential (} Two -Family Residential O Demolition ( ) Utility Construction () Industrial (} Church (} Factory/industrial (j Modular (j Residential Hotel (j StoragelWarehouse {) Utility New Building Construction O Institutional