NCC224147_FRO Submitted_20221219

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"'j_ SOIL EROSION and SEDIMENTATION CONTROL
Lincoln Cl Natural Resources Department
115 West Fain Street, Lincolriton, NC 2809� 704-736-8501 Fax [phone]
No person may initiate any land -disturbing activity on one or mere acres as covered by the Act before this form and an acceptab e
erosken and sedimentation contra' plan has beers completed and approved by the Lincoln County Natural Rescurccs Department
(Please type or print. If the question is not appk;abie or the e-mail and/or fax information unavaNib:l place N,A in the Olaf* )
Part A
1. Protect NameMidtown Business Ill - Lot 12
2 Location of land -disturbing activity Latitude35.444111 Longitude-61 271428
Parcel Identification Number (PIN)3622345204 Watershed AreaWS-IV PA
HighwayiStreet AddressMdt_own Dr
3 Approximate date land -disturbing activity will commence November 18. 2022
4, Purpose of development (residential, commercial, industrial, institutional, etc:) Industrial
5 Total acreage disturbed cr uncovered (including off -site borrow and waste areas) 0.30
6 Amount of fee enclosed, $200 L The Standard Permitting appllcatEcn fee of $200 00 per acre
(rounded up to the next acre) is assessed without a ceiling amount (Example 9 acres total $1,800) The Express
Permitting application fee is a dual charge The normal fee of $200 00 per acre (rounded up to the next acre) is
assessed without a ceiling amount. In addition, the Express Permitting supplement is $250 00 per acre up to eight
acres, after which the Express Permitting supplemental fee is a fixed $2,000.00 (Example. 9 acres total $3.800 00)
7 Has an erosion and sediment control plan been filed? Yl No Enclosel
8 Local appointed person to contact should erosion and sediment control issues arise during lard -disturbing activity
Namelgor Shiper E-mail Addressi orraceboffice com
Ielephene919-274-3200 Cell # L Fax #
9 Landowner(s) of Record (attach accompanied page to list additional owners):
CAROLINA ELITE BUILDERS LLC 919-274-3200
Narne Telephone Fax Number
205 S ACADEMY STREET 205 S ACADEMY STREET
Current Nailing Address Current Street Address _ —
UNCOLNTON NC 28092 LINGOLNTON NO 280�J2
City State Zip City State--
10 Deed Book No 3149 Page No 686 most fecently Fled in L-ncoln County Register of needs
11 Future Landowner{sl if applicable (attach accompanied page to list additional owners)
Name Telephone Fax Number
Currerit Maihr, g Address Current Street Address
.------ _-
f:ity State Zip City Stale Zip

SOIL EROSION and SEDIMENTATION CONTROL
Lincoln County Natural Resources [department
115 West Main Street, Lincoin ton, NC 28092 704-736-8501 Fax [phone]
FINANCIAL RESPONSIBILITY i OWNERSHIP FORM
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 an attached sheet)
Igor Shiper igor@cebofflce com
Name
205 S Academy St
Current Mailing Address
Lincolnton NC 26092
City State Zip
Telephone[phone]
E-mail Address
205 S Academy St
Current Street Address
Lincolnton NC 28092
City State Zip
Fax Number _.._
2 (a) If the Financially Responsible Party is not a resident of North Carolina, give name and street address of We
designated North Carolina Agent
Name
E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Telephone Fax Number
(b) If the Financiady 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
Current Mailing Address Current Street Address W
City State Zip City State Zip
Telephone_ Fax Number.
(c) in order to facilitate Permittfng it is necessary to be able to contact the Engineer or other consultafit who can
assist in providing any necessary information regarding the plan and its preparation
iw ng neering Firm or other consultant E-mail Address
Current toailing Address
inditi ideal Contact person (t. pe or print)
ity State Zip
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w'".y"e
I SOIL EROSION and SEDIMENTATION CONTROL
Al
` .. Lincoln County Natural Resources Department
'115 West (Main Street, I-incolnton INC 28092 704-736-8501 Fax [phone]
FINANCIAL RESPONSIBILITY / OWNERSHIP FORM
(d) Contractors andfor Subcontractors (person(s) or firm(s) engaging in the land -disturbing activity
Igor Shiper
Igor Shiper
Name of Person or Firm
Name of Person or Firm
205 S Academy St
205 S Academy St
Current Mailing Address
Current Street Address
Lincolnton NC
28092 Lincolnton NC 28092
City State
Zip City State Zip
Igor Shiper
Individual contact person (type or print) Individual contact person (type or print)
Telephone[phone]
Telephone[phone]
Fax Number
Fax Number
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 by any change in the information provided
herein and any other associated documents I understand that all documents that are associated with this project and
project number are parts of the complete project document
Permission to Enter on Land
I certify that I am authorized to grant and do in fact grant permission to the Natural Resources Erosion Control Inspector
and his agents to enter on the land in question in connection andlor related to this permit.
Igor Shiper
;T4ypeori ame
Signatur -'
Owner
Title or Authority
ii�- /,?`';g
Date
i. '::�u5a-,, e . Qea,( , a Notary Public of the County of i r V,{a In
State of North Carolina, hereby certify that t� ° r' Pcr _ _appeared personally before
me this day and being duly sworn acknowledged that the above form was executed by him
NnrOQdo-16.r 2oy�-
lrhtness my hand and notarial seal, this �� day of i�
h,\+ sty f-t �k+� NotarIt
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My commission expires 0�' b'Y -'- r .