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HomeMy WebLinkAboutNCC230191_FRO Submitted_20230131cPitt County Planning Department Development Services Building �o a4 1717 W. 5th Street Caszo�~ Greenville, North Carolina 27834-1696 Telephone: (252) 902-3250 James F. Rhodes, AICP Fax: (252) 830-2576 Director Financial Responsibility / Ownership Form Soil Erosion and Sedimentation Control Ordinance No person may initiate any land -disturbing activity on one or more contiguous acres as covered by the Act before this form and an acceptable erosion and sedimentation control plan have been completed and approved by the Pitt County Planning Department. (Please type or print and, if question is not applicable, place N/A in the blank.) Part A. 1. Project Name 2 3 Project Gen4 Location of land -disturbing activity: County Pitt City or Township Ayden , and Highway/Street Pepsi Way Approximate date land -disturbing activity will be commenced: March 2023 4. Purpose of development (residential, commercial, industrial, etc.): Industrial 5. Approximate acreage of land to be disturbed or uncovered: 18.1 6. Has an erosion and sedimentation control plan been filed? Yes X No 7. Person to contact should sedimentation control issues arise during land -disturbing -activity: Name Matthew Kiker Telephone 980.201.5519 8. Landowner(s) of Record (Use blank page to list additional owners) Minges Bottling Group, Inc. Name(s 128 epsi Way Name(s) Current mailing address Street address Ayden, NC 28513 City State Zip City State Zip 9. Recorded in Deed Book No. 1344 Page No. 202 Part B. 1. Person(s) or firm(s) who are financially responsible for this land -disturbing activity (Use the blank page to list additional persons or firms): Frampton Construction Name of person(s) or Firm(s) Name(s) 4500 Cameron Valley Pkwy, Suite 220 Current mai I ing address Street Address Charlotte, IC 28211 City State Zip City State Zip 973.985.2954 Telephone Telephone 2. (a) If the Financially Responsible Party is a Corporation, give name and street address of the Registered Agent. Name(s) Current mailing address Street Address City State Zip City State Zip Telephone Telephone (b) If the Financially Responsible Party is a Partnership give the name and street address of each General Partner (Use blank page to list additional partners): Name(s) Name(s) Current mailing address Current mailing address City State Zip City State Zip Telephone Telephone 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/her attorney -in -fact or if not an individual by an officer, director, partner, or registered agent with 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. Timothy Soder Project Manager Type or print nam Title or Authority Jilnot�r -gorCer 10/6/2022 Signature Date I, i r `C.�l SSG iyr)DL-)(- , a Notary Public of the County ofState of , hereby certify that Tryl kg 508-fir 50v-0n appeared personally before me this day and being duly sworn acknowledged that the above form Caro I, rA was executed by him. Witness my hand and notarial sealthisCc day of OLJ-R�>ef- . 2022. Notary YYlly ,,�:+�z•a MELISSA HONOUR DIO ARY PM W, STAXOFWM CAROlMIA My CommEssion Expires 412612023 My commission expires 2- j 2°z 3