NCC231863_FRO Submitted_20230614

https://chathamcountync.viewpointcloud.com/categories/1082
Land-Disturbing
�'r 1 rr r:k ['c ,ir� Permit Application
Please include all required signatures.
1'car Office Use:
Physical Address Mailing Address
80 East St. PO Box 548
Pittsboro, NC 27312 Pittsboro, NC 27312
Phone: [phone]
Please see PERMITTING FLOW CHART to determine which permit, plan,and fee requirements
apply to your project and then check one of the boxes below:
Land-Disturbing Permit. The following items are required to obtain this permit: completed
application, plans, deed, and fees. All clearing and disturbance must be included when calculating
disturbed area.
Fee Requirements:
See attached PERMITTING FLOW CHART
For fees that are rounded up to the next whole acre.
Example: 1 acre or less is $500, 1.01-2 acres is $1,000, and 2.01-3 is $1,500.
Plan Requirements:
Design Plan: submit (1) copy of an erosion control plan completed &sealed by a professional land
surveyor, professional engineer, or registered landscape architect. This plan must meet the criteria of the
Chatham County Erosion Control Plan Review Checklist and include all applicable construction details.
These can be found on the Chatham County Watershed Protection website, on the Erosion Control
webpage. This plan must satisfy all local, state, and federal minimum plan requirements.
General Plan: submit (1) copy of site plan showing proposed disturbance limits along with the Chatham
County Residential General Plan. Site plan is not required to be completed by a design professional. The
Residential General Plan can be found on the Chatham County Watershed Protection website,
Residential Land-Disturbing Permit wcbpage. Complete table on sheet 1 of Residential General Plan.
® Residential Lot Permit, The following items are required to obtain this permit: completed
application, site plan, and fee. Page 3 "Financial Responsibility/Ownership Form" not required.
Fee Re uirements: Plan Requirements:
$100 flat fee Site Plan showing property boundaries and proposed disturbance limits. The site
plan required by the Environmental Health Department can be used as a base.
AI.I.CHECKS MADE PAYABLE TO CHA'I'HAM COUNTY
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c•IIA1 tr fV% C'( )ttN t-1
Land-Disturbing
'' ' ' •' Permit Application
**The mailing and street address of the principal place of business for the person/entity financially responsible and
the land owner(s) must be provided.A P.O. box is NOT acceptable as an address.
**If the financially responsible person/party is different from the current land owner,an agreement signed by both
parties must be provided allowing the financially responsible party to conduct the land-disturbing activity on the
property.
PROJECT NAME: en ood.tomes.ChapeLEidge at Act31 DATE: /'7/2
ADDRESS OF PROJECT: /.X,� _.6'ram,r7y (I
LATITUDE/LONGITUDE OF PROPERTY AT SITE ENTRANCE:..3-C 790.-N// 7y.2//Su3
PARCEL#(S): 2f� �
TOTAL DISTURBED ACRES or SQUARE FEET:
PURPOSE OF ACTIVITY: Build New Residential Home
FEE AMOUNT SUBMITTED: $100 RIVER BASIN: CAPE FEAR
"LA NDOWN} R(S)OF RECORD (attach page to list additional owners)
Please provide a complete list of partners, managing members and registered agents if the responsible entity or
land owner is a group of individuals, corporate organization or entity.
Name' -Weeds-Holdings LLC Phone: 91
Addres, 20d Twany(.hacp nr Rateugttic:276 / - E-Mail: [e-mail]
Signature: ..
**FINANCIALLY RESPONSIBLE PARTY (applicable only IFdilibretti from Property owner)
Name: _ Phone:
Address E-Mail:
Signature:
NORTH CAROLINA AGENT(applicable only if owner or financially responsible party does not reside in
North Carolina)
Name: Phone:
Address: — E-Mail:
Signature:
ENGINEER/SURVEYOR EROSION CONTROL,
Company Name: Residential Land Services PLLC _ Person to contact should erosion &sediment
Address: __917 Evansiae_Qary_NC 27513 control issues arise during land-disturbing activity:
Contact Person: 1;naritsnapa`
Contact Person: . - Dean Rhodes_ - Company Name: Glenwood Homes
Phone: [phone] Phone: -919_60S-8502
E-Mai I: .-,.___ieau ria-nc gom E-Mai lehadvgtenvtQadttotnessadn
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ANTICIPATED START DATE: 7/1/23 ANTICPATED END DATE: 6/31/24

Soil Erosion and Sedimentation Control
('I rot 1 I All (' )tar 11'
" ' " ' • It ' ` • Financial Responsibility/Ownership Form
NOT REQUIRED '10 BE(.'OkJPLE771)1 OR Rt S/DliN'1'1.AI,LOT PERMITS,
PLEASE READ TIlE FOLLOWING INFORMATION'
1)This section must be signed in the presence:au Notary
21 All Land-Disturbing permits lire valid for up to (2) years from the dine of issuance. If citcuntstanees tt.i i,un the permit may he
extended for (2) years per the conditions of the Chatham COMM' Soil I:rasion and Sedimu►toUon Control c htlinanee. IJpon+%ritlen
notice, the land-Disturbing permit may he revoked for failure to comply n ah the thdinancc. II' the permit ix revoked, all other
peninis and approvals are withheld until the property is once again in compliance With Chatham Comm' egulations. Also,upon
mitten notice,a civil penally(line)can he instigated against the property to ncr and/or additional financially aesltonsible pally of any)
lit violations of lh❑Uhatluun Cuunly Soil firosiun turd Sedimeniation Control t)rdinance.'I his penalty is up to S3000.00 pet violation
per day and is assessed daily, for every day the properly is in violation. Interfering with or hampering an inspection can result in a civil
penalty without 1l'Alen notice,
3)The in lbrmation provided on this Ionn is true Itad comet to the bust or my knowledge and belief aad was provided by me while
under oath.
.1)This limn must be signet! by the property(inner iI'an indi+ulual II'owned by a company or cotporal►un,this font)must he signed
by an officer. director, partner, attorney-in-loci, or other person with authority to execute instruments for the cotporation and
accompanied by tit complete list of all partners,managing mentbe+s,Ind registered agents of the company ltreorporatioii.
OWNER OF PROPERTY:
Name and Title: Edwin Woods Managing Member
Company (if applic4.1 }: Woods Holdings LLC
Signature: .j
ADI)I'I IONAL FINANCIALLY RESPONSIBLE PARTY Orally):
Name and Title:
Company:
Signature: .__
NORTH CAROLINA AGENT(if
Name and Title:
Company:
Signature: _
****e**:le*********Li ***k******of:**xt *****:I;*****************y:*x******
I. `✓� , � Q 2 � . a Notary Public of. Gl � County in the slate
or OO f`I" ,eL,f,rc `./lam do hCt'cbv ccrlifv that Et4 i r1 (000 CL
S personally
appeared before Inc this day and under oath acknowledged reading the information above and acknowledged that the
above coral was executed by him or her.
tk
Witness my hand and official scnl, this the day of w-tat. 20
Notary Public •�`��►��•• oN •,�S►O.,
Nh� commission expires 3 __ _1��?-(_.Q- - �(SQ.AI.NOTAI�y
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PUBLIC
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