NCC191694_ESC Approval Submitted_20190904

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9/3/2019
USIOD Salem
Project Overview
Permit Application
Glad Acres - Phase 1
City Hall Building
101 N. Main Street, Suite 53
Winston-Salem, NC 27101
Fax: [phone]
Project Name: Glad Acres - Phase 1 State: NC
Jurisdiction: City of Winston-Salem County: Forsyth
ProjectlD: 234492
Financial Responsibility/Ownership Form
City of W-S Stormwater & Erosion
Control
Project Name: Glad Acres - Phase 1 Address(es), Parcel(s), or PIN#(s):
• 5896-04-1054.00 (Unverified)
Project Information
Additional Location Information: Project is Phase 1 of
a potential 2 phase project.
Purpose of Grading: Residential Single Family
Subdivision
Acreage to be Disturbed: 25.1
Land Owner of Record
Property Owner
Gladys Doub
5934 Glad Acres Rd.
Pfafftown, NC 27040
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[e-mail]
Contractor Information
• 5934 GLAD ACRES RD (5896-05-0046.000)
Approximate Date to Commence Land -Disturbing
Activity: 01 /01 /2019
Total Acreage: 62.3
Value of Grading Contract: 250000 Has a project contractor been selected?: No
Please choose which Contractor number you will be
providing:
https://winston-salem.idtplans.com/secure/project/permits/?step=permitdataprint&permitid=61810 1 /2

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City of W-S Contractor's ID M
Permit Application
Contractor's NC License Number:
Financially Responsible Parties
Person(s) or Firm Financially Responsible
Ronnie Parker
RS Parker Homes, LLC
PO Box 5967
Greensboro, NC 27262
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[e-mail]
Is the financially responsible party an out-of-state
resident?: No
Is the financially responsible party part of a
partnership?: No
https://winston-salem.idtplans.com/secure/project/permits/?step=permitdataprint&permitid=61810 2/2