Land Disturbance Permit Application Form - Macon County printable pdf download

MACON COUNTY

LAND DISTURBANCE PERMIT APPLICATION

(MUST BE FILLED OUT COMPLETELY)

APPLICANT

***OWNER OF SUBJECT PROPERTY***

Name: ______________________________________________________

Phone: _______________________

Address: ____________________________________________________________________________________

***CONTRACTOR / EARTH MOVER***

Name: ______________________________________________________

Phone: _______________________

Address: ____________________________________________________________________________________

Licensed Macon County Contractor? Yes/No

Macon County License # : _______________________

Estimated Cost of Grading: ___________________________

N.C. License # : _______________________

***PERSON FINANCIALLY RESPONSIBLE (If Different from Owner)***

Name: ______________________________________________________

Phone: _______________________

Address: ____________________________________________________________________________________

LOCATION

Macon County Land Records

Township ______________________ City Limits of Franklin? Yes / No

Property Identification #

Directions to Property:___________________________________________

(Parcel Number)

_________________________

_______________________________________________________________

PROJECT

Size of Land Disturbance _______________Sq. Ft. or _______________ Acres

(43,560 sq. ft. = 1 Acre)

*Erosion Control Plans are required @ 21,780 sq. ft. (1/2 Acre) Disturbed.

Are you applying for a building permit as well? Yes / No If yes, square footage of structure: ___________

Will the land disturbance involve a slope of greater than 1:1 (45º)? Yes / No

(If yes, plans are required)

Do you have water on your Property?

No / Yes

Spring

Lake

Branch

Pond

Stream

If you have a stream, is it a N.C. Trout Stream? Yes / No

(Requires 25 foot buffer zone)

Will the property require a stream crossing? Yes / No (Requires permit from Department of Water Quality)

Mandatory Measures

*Groundcover: Revegetate within 21 calendar days upon completing any phase of grading

*Silt Fences (Steel Posts 6’ O.C. trenched 8” Deep) or Berms and Diversions

*Mudmat/ gravel construction access (3” Stone: 50’long and 10’ W )

*Cut slopes 1.5 : 1 Fill slopes 2 : 1

Road Grade Standards

16 % - Pavement

10% - Gravel

6% - grass

The undersigned hereby attests that the information given above is true and correct. The applicant is aware of the stated

requirements and responsibilities for land disturbance in Macon County. The applicant understands the principles of erosion control

and understands that the North Carolina Sediment Law of 1973 applies to each project regardless of size. The applicant

acknowledges that county staff can and will conduct periodic inspections of this project to ensure compliance. Any non-compliance

with the provisions of this ordinance may result in civil penalties. The signature below signifies full responsibility for all land

disturbance activities on subject site.

Signature of Financial Responsible Party/Owner: ___________________________ Date:______________

Land Disturbance Permit Application Form - Macon County

Related Articles

Related forms

Related Categories