NCC240554_FRO Submitted_20240305

PLAN REVIEW/FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
CATAWBA COUNTY CODE OF ORDINANCES, CHAPTER 16 ARTICLE V
SOIL EROSION AND SEDIMENTATION CONTROL
No person may initiate any land-disturbing activity on one or more acres as covered by the Ordinance before this form
and an acceptable erosion and sedimentation control plan have been completed and approved by the Catawba County
Utilities and Engineering Department. (Please type or print, and if question is not applicable,please N/A in the blank)
PART A
1. Job Name AROLINA CONTAINER LLC
2. PIN or 911 Address12792-0509-8952,2793-1700-8182,2793-1700-8259,2793-1700-9228,2793-1710-0276,2793-1710-2206
2793-1710-1111
3. Purpose of development (residential, commercial, industrial, institutional,etc.)INDusTRIAL
4. Approximate soil disturbance date fr8D
5. Total acreage disturbed or uncovered (including off-site borrow and waste areas) p.45 AC
6. Has an erosion and sedimentation control been filed? fl Yes IT No X Attached
7. If you have an Erosion Control billing account,would you like this to be billed? IT yes X No
Account Number FV/A
PEQPLE
8. Person to contact should erosion and sediment control issues arise during land-disturbing activity
Name [e-mail]
Jonathan Leerkes E-mailL-maal address @
Telephone 11 Cell# I3369471370 ! Fax#
9. Landowner(s)of Record (attach accompanied page to list additional owners)
Name CAROLINA CONTAINER LLC Telephone f Fax#
Current Mailing Address 51 30TH ST NW
City 51 30TH ST NW State � Zip 128601
Current Street Address 1 30TH ST NW
City fsi 30TH ST NW State Zip 28601
10. Deed Book No. 1 3286, 37581, Page No. F-0609, 0228,
3584, 3456 0, 0372,
PART B 3478, 2181 0230, 0452
1. Person(s)or firm(s) who are financially responsible for the land-disturbing activity (Provide a comprehensive list
of all responsible parties on attached sheet):
Name AROLINA CONTAINER LLC E-mail address Fs@caro11nacontainer corn
Current Mailing Address 130 Box 29622
City Ilaleigh State �C ! Zip 127626

Current Street Address 121 30TH ST NW
City FHCKORY State I C Zip I28601
Telephone [phone] Fax# I
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 I
City I State Zip
Current Street Address
City I State I Zip
Telephone Fax # I
2. (b) If the financially responsible party is a Partnership or other person engaging in business under 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 E-mail address
Current Mailing Address I
City I State Zip I
Current Street Address
City I State Zip
Telephone I Fax # I
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
•de corrected information should there be any change in the inf ation ovide herei
1 1 PV
T or Pr' t N. 4 Title ofii:.).itIvori ./ ,
1,11p / A-
Si 'a Date
I, SUSaincRl C C UCd , a Notary Public of the County of lYe Cie State of North
Carolina, hereby certify that Rer 'je.6stor\5 appeared personally before me this day and being duly
sworn acknowledge that the above form was executed by him. 1
Witness my hand and notary seal,this 15 day of June ne ,202 3
Seal RIDDLE
ki.Ctotes-
NS;14-11-Ak-
Well County
NorthC My Commission expires 55/I qI 2028
*Commission Expires May le.202$
Print Form