NCC223532_FRO Submitted_20221013

I and -Disturbing
('t " • • ` Permit Application
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p13jiECil.�a.:.rC+: �ls.i'r.> i;�;rt>s
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Picric see ?ER-VITTINso C I: %R T to t3clertrrrbc tialus.r permit ano;i a •c4u.-C•stcn:i appl;
.csr F-,C?c_t a:,; r,e^ �c.k .,. }' i _uses L,clo�•
L, Land-Drsturbsng Permit in,- i—i.aw,ng stem, in requ::ti crmst roc1^-e:cj
sPPIs n sr inj tcc-i Land-Dssturbin^ n•_rn; r srplrcrh,-n, m_st ,,•,.'(��c a.l par.ela'o�s
wic ^�".��*[ - .41t 1 tFc IotxJ amotrttr (1ldt►i.l': i. ` al t�.'-FL',evtng il',.. v1tUAw,:;
rnust C-c !r.,;(,i:%; .%hcn catcutstuit disturbed
_ F et Rcg_-r--ncna—
Pc[rrttt tGC S_ti4
PlanRn;cv► Fcc 5250.d,.[ -! --
Fees are roumled up to the nc, -
E.arnn Ic_1 urc or lc%% (s SSth) ' _`1-�a.rc�"jl,i[l}i), 3rt.] � U: 3 is Si >tv
Plan Retu�rtmrnt�
Design Plan_ -Smil i 1 I tiop% of sn trv!wn :un1n'1 ply iCtimpketed & sciled b% a pt'jfM10" iar—'
tonal trasnccr 1r :-5,sEvcd Iands,-apc zrchitect This p'an rn..s: rnet: the critcr:a cr -.-
Chathar:. C Cuntrot Piar Rc►icw Cht_khif and rncludc Al appL.z-ble Lomwuctioa dct:�
Ihese can b::. -.;.rid un the C J'taiham t sans. Vt atersheJ Pmtc.tion w(:bmtc. %m [lu Ero,iun C(>MMI
_,%Cbrs c Th., LOn must ,atrst. all -.a;. Ntstc. JM fCtkfAl rtunrrnutn plsn trqutrrrsurits
General Plan ►ubmst I I t ww- of .sic plan Along with the Chatham Count. Rcssdmtal Gen" Pisa Site
plan t. n:at requited to he --ornpivc-s: t-. a de-ign protcnsronai The Rcvj. miss t,eneral Plait can be found
cm the [ nzthsm ount-: %%atcmbcd Pwic nun websrtc or, the kc.tdrnnzil Ccr..t-jLi!cr. Acbpage lndwW
Jut d-asr:.:-e pattcm if s s un '+hcrt I �f tin Re-.i ent►al General Plan --
] Resttitatbal [at Permit Ire felk—oll,, rtcm. arc rNuitci to obtirn ths. V�C'ri a %.twnp[c'tcd
application sste plan. and fee PArsE t A INA\t.'LAL REWNSIBILITY tlw'VF-R5HIP FORN"'
nut rcquirc-J _ — -- - . —
1-cc F?cgutrcrncnts Plan Rc(.turrerrt_nt► _. _.
SIof) flat ftc i Site Plan sha.+sng propertr boutxiarttms 1 he sstc plar. requued by the
_ _Ensir©rtmcntal Health or Central Pcrtnimn Lh +rtrnents n s1H(f- enl
;L 4 Wt-KI! %IAL►F P.A•i A3LE it) Cti.kIHUNCIx tiT",
Pike 1 :.' 3

t 1 IA 11 I% a t 4 e; t. t, Land -Disturbing
, Permit Application
"The maillog and street address of the ptiac4W place of buslocss for the persanientitY imanciallY ntsW"hb and
the laid owner(s) coast be provided. A P.O. bot is NOT acceptable as an address.
"If the ftsucially responsible person/par" is different from the current land owner, ao agrtiemeat 4PW by bath
parties most be provided alhewing the financially respomible parry pereon to conduct the land -disturbing attkW un
the property.
PROJECT NAME: Bra^ & Am Sir Rescue
ADDRESS OF PROJECT: 45 Indeen Orchard Rd
DATE: 10-22.202'
LATITUDEAANGITVDI= OF PROPERTY AT SITE F-VM'%CE- 1r35 50Or W'79 171S'
PARCEL tits): '77 7143
3---
TOTAL DISTURBED ACRES., SQVARE FEET: 2 0 _
PURPOSE OF ACTIVITY: iiO= Ssnt--
FEE AMOUNT SVBMITTED: is It9'a 00
"LANDOWNEWS) OF RECORD (attach ge to list additional iwwrtenl
Please provide a complete list of partners, tang tmcmbm and mgtstard tents if the responsible entity or
land owner is a group of individuals, corporate organization or entity
Nano: BMM a Ann Svatnar p1 ttOg- '3Z42
Address. 400 Sam= Vtow Or E-Mail.
Chapol HM. NC 27514 Stgnattur Aj,
"FINANCIALLY RESPONSIBLE. PART' lmtlocable- only if AdI'e:rettt fmAl 00WISY awtteerl
Nam: Fox General CentractoM tnc- per- 9194133-2445 _r
Address: 618 Johnny Lindley Rd. E-Mail 1Qx9cn 3r_1d Qam
S4er City. NC 27344 Stgwtwre — _4�_
f ffl= C'AROi.I A AGENT tmmitcable only ((aarter at financially a ns( le , ae�tmuf�l�
Not1h C:a hnfl)
CmV Foes 336.2646571 p��.
Nattx ..._.�.
Address 518 J&Wy Ley Rd. .. E•Mad #0x3 s
Siler City. NC 27344 - -- -- - Stgnatnne .--
Wq
company J+ o= hoer" i Mew. P E
Address P O Sox 278
Asheboro. NC 27204-0278
Contact Person".._ --
Phone• 3364ra4l6W336.493-4450
E-Mall. tvnerseaessr�tnaeibas n can+ --- -- .-
EROSION CONTIM
Person to contact shooed erosion & redlmeat
canwal issues calm daring land-11sturN119 actw ":
Conrad Person CM9 Fos
Cry Na= Fox Genera! Cantmc:W s, tnc
Pbone 336-264GS7t
Page 2 of 3

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Soil Ertt'sion And tiedifnrnlatiun ( ontrul
i'fl�le tt »ti [ .1.rtlr� t �
' Hnandal Kespon0hililyA)"ner%hip Farm
., IT RIVN. 1y: i ', r .r..o1 (r.yifP[T_TiD f ttk REA, : _ "•T1A1 Ltl! YFR1!!75
Pi is Ash itf AU THE R . rf.L(7ik IttiEQRA1AJ—Jt-,ti
I t Th:s rrtu,t tic upcd Kt the prr.c rwe :,1 A y.-la ,
i All f�.'s3 tharwh:rrg perrtutt air %rind t..r up 1, ,: +r.&.: 1r.:: t OW U C ,. — . - It .::_L . u :.: w T.nr t!x PC-- . T... h�
v%or mind ta: i.' ,'rat• pr: Lhe ..:a't<rla,Lis. to Ox t I'athAr` 1 .wrnt-, Suit irC.s.r zt-,! tirafsrr,cruI .,F. I r'jLy+ I *dIPAOCC C-V'or VM1*1pfl
n.m.c the tan.l ihururbirtir prsrrr! nu+ ti 1r,4", 4— 14,vrr W ctxnrt, +:r ::r .ai,narx: c pC"W4 .1 rv.aked 4b adier
perrtlt Ml 11, ,t..+ah die „IWIX d unt:f tht prufwr, $Cain :n r.yr'p- aca. wlrh r ".1 i.:r" ..xrn rcrslailon- %io 4w
u'nircn r•-,tic a c 1,11 penal[-+ ttwwI can tic rn,ttgatc,: : - = rTopmq o,al1[r m4 ti w'dltio"! IIrUrTC:11j,. respon#tb,! r&-M .4 AM%!
fut utolana-ts of thr Chatham: (orrr% +•nth Fro+ton x•_ ntaaavtr (at:-nof i)-d rarxc Fht, r e: a :sip to 55W OD Per "lsl—
per day sr.,! is "-,t cd ,fail-, far c%crs .tar 1he Iuup - ;.:: a :%Astwn fn rfcrr€ .itt- %w tl:mt+cnr. : a=...-mpe,et►oo cm rcuil, al a entl
penaln utrhottt A-nttcn rtattcc
1) The inf.xmaliurl rtootdcd an rota l,,rnt r+ true sfxl; *enc,t u- the berm m r-. lft%a L r vul De1:et aml .:a.t cr,i,tdcal by me wif,ic
urulct .rash
at Thls form mutr ttr ttfrn•d h, tM l,r:+f1cm. outrer rl ur m dt.rdual if mown c-d t!, a rr44nr ,:r ,.)rpwva%w % thn Ior:n rrralt < t:17rcJ
by sa of nct_ drrem harm,:? stuv*x►-in-f tct, ce te'aer peraoe wsth t_ t:teA,trtc--ourwrvM1 lot the corpocm!oa And
aeeotr;rAtsred b? a-ompkte int .11 all parvun, rnxaafattLt rtaernk+eta And rc[na-rr.: JV;-%:s .-(thr .RlWM&n) ew co pontwn
OWNER OF PROPERT1:
Vanir and Tittr Snan & Ann Sum.-w - --
L'tunpim (it sppllcdbkt — - - -- - - - —
SignutUtc — .oe.
ADDITIONAL FINANCIAU I RESPOSSiBLE PAR rI of anc is
Name and I We Craig Faa -- —.
Company Fcm Gergerdl Crntrx--kxs—lts, - — - - — - --
Slbrnaturr
NORM ( Al 01 INA AGF H t (of ani ).
Nam; and 1 ilic CtO19 Fox
Compan) FCa Gegplral Comractom tree _ -
signeurr f
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