NCC233053_FRO Submitted_20231011

LINCOLN COUNTY DEPARTMENT OF PUBLIC WORKS
, i r 1 1 5 WEST MAIN STREET,2N0 FLOOR CITIZENS CENTER,LINCOLNTON,NORTH CAROLINA 28092
PHONE [phone] FAX[phone]
CAAO\
DEVELOPER CONTRIBUTED ASSET PROJECT
LETTER OF INTENT
It is the intent of Enter Developer Name to convey to Lincoln County Public Works the
Choose an item of Enter Project Name for ownership upon satisfactory completion of
construction, in accordance with the Lincoln County Public Works approved plans and
specifications.
The proposed limits of conveyance arc as follows:
If any part of the said utility system(s)extends into private roadways or private property,
easements and an indemnity(hold harmless)will be granted as required by Lincoln County.
It is our intent to have Enter Engineering Firm Name provide construction inspection services to
ensure that the project is built in accordance with the plans and specifications, and to the
minimum standards of Lincoln County Public Works,and in accordance with the Lincoln
County Public Works Design Manual.
We understand that a certification will be required by a Professional Engineer, indicating:
i. That all construction was observed by him, or his representative; and
ii. Work has been completed in accordance with the Lincoln County Public Works approved
plans and specifications.
Very truly yours,
Matthews car wash of NC LLC Onsite Civil Group of the Carolinas, LLC
Owner/Agent&/or Name of Corporation Na 1-e of E.;'nep>�ing •
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Signature ` •_na, re of Engineer
Developer
Title v4 F�ss,o .
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Note t�
If signed by"Authorized <6� F c, ti
Representative/Agent",please attach a iti c►+as\-
Letter of Authorization Seal of Engineer of Record
1304 Letter of Intent July 2019

Print Form
SOIL EROSION and SEDIMENTATION CONTROL
Lincoln County Natural Resources Department
115 West Main Street, Lincolnton, NC 28092 704-736-8501 Fax: [phone]
FINANCIAL RESPONSIBILITY / OWNERSHIP FORM
No person may initiate any land-disturbing activity on one or more acres as covered by the Act before this form and an acceptable
erosion and sedimentation control plan has been completed and approved by the Lincoln County Natural Resources Department.
(Please type or print. If the question is not applicable or the e-mail and/or fax information unavailable, place N/A in the blank.)
Part A
I. Project Name Matthews Carwash _
2. Location of land-disturbing activity: Latitude 35.5164 Longitude-81.0048
Parcel Identification Number(PIN)4604395070 Watershed Area
Highway/Street Address Lot 2 Grande Lake Crossing-section 2,Grande Smile Ln.
3. Approximate date land-disturbing activity will commence:
4. Purpose of development(residential,commercial, industrial, institutional,etc.):Commercial
5. Total acreage disturbed or uncovered (including off-site borrow and waste areas):1.14 AC
6. Amount of fee enclosed:$400 .The Standard Permitting application 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? Yes No Enclosed X
8. Local appointed person to contact should erosion and sediment control issues arise during land-disturbing activity:
Name Kent Hughes E-mail Address [e-mail]
Telephone [phone] Cell# Fax#
9. Landowner(s)of Record(attach accompanied page to list additional owners):
Matthew car wash of NC LLC 630-845-3141
Name Telephone Fax Number
7916 Chapel Creek Dr.
Current Mailing Address Current Street Address
Denver NC 38037
City State Zip City State Zip
10. Deed Book No.3099 Page No.916 most recently filed in Lincoln County Register of Deeds.
11. Future Landowner(s)if applicable: (attach accompanied page to list additional owners):
Name Telephone Fax Number
Current Mailing Address Current Street Address
City State Zip City State Zip

SOIL EROSION and SEDIMENTATION CONTROL
Lincoln County Natural Resources Department
RAatr 115 West Main Street, Lincolnton, NC 28092 704-736-8501 Fax: [phone]
FINANCIAL RESPONSIBILITY / 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):
Matthews Car Wash of NC LLC [e-mail]
Name E-mail Address
7916 Chapel Creek Dr.
Current Mailing Address Current Street Address
Denver NC 28037
City State Zip City State Zip
Telephone [phone] Fax Number
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 E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Telephone Fax Number
(b)If the Financially 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
City State Zip City State Zip
Telephone Fax Number
(c)In order to facilitate Permitting, it is necessary to be able to contact the Engineer or other consultant who can
assist in providing any necessary information regarding the plan and its preparation:
Onsite Civil Group of the Carolinas, LLC [e-mail]
Engineering Firm or other consultant E-mail Address
980 Birmingham Rd, suite 501-340 Milton GA 30004
Current Mailing Address City State Zip
Jarrett Senkbeil 404-822-9147
Individual contact person(type or print) Telephone Fax Number

'``/. SOIL EROSION and SEDIMENTATION CONTROL
•
J J
Lincoln County Natural Resources Department
115 West Main Street, Lincolnton, NC 28092 704-736-8501 Fax: [phone]
FINANCIAL RESPONSIBILITY / OWNERSHIP FORM
(d)Contractors and/or Subcontractors(person(s)or firm(s)engaging in the land-disturbing activity:
Name of Person or Firm Name of Person or Firm
Current Mailing Address Current Street Address
City State Zip City State Zip
Individual contact person (type or print)Individual contact person (type or print)
Telephone Telephone
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 and/or related to this permit.
13�r ac a k v '- he_J¢_\ofQr
T e or rint name Title or Authority
it_3.aa
Signature • Date
I, rno,f% 1. 12)ObnP ,a Notary Public of the County of L.C-C G` S
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State of NAl, ,a, hereby certify that a o.r 6ctra l C H v he s appeared personally before
me this day and being duly sworn acknowledged that the above form was'xecuted by him.
Witness my hand and notarial seal,this 3 day of no Lee i bet-, 20 )--
,`. pill Ai. �i,io Notary
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My commission expires � L n� d�
-=� MARI F.BOONE
=* *= NOTARY PUBUC-OHIO
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