NCC221637_FRO Submitted_20220428

/1_0_ ' Gaston County
tw _F Gaston Natural Resources Department
O 1303 Cherryville Highway, Dallas, NC 28034 Telephone: [phone]
ga
Soil Erosion & Sedimentation Control
la q; Financial Responsibility/Ownership
,
No person may initiate any land -disturbing activity on one (1) or more acres of property in all portions of
Gaston County, except for that property within the city limits of the incorporated municipalities of Gaston
County who have not adopted the Gaston County Soil Erosion & Sedimentation Control Ordinance,
before this form and an acceptable Soil Erosion & Sedimentation Control Plan have been completed and
approved by the Gaston County Natural Resources Department's staff.
(Please type or print and, if question is not applicable, place N/A in blank)
PART A:
1. Project Name
2
The Terraces
Location of land -disturbing activity
City Cramerton Highway/Street Hamrick Rd.
3. Approximate date land -disturbing activity will commence
4.
5.
6.
Purpose of development (residential, commercial, industrial, etc.) Residential
Total acreage disturbed or uncovered (including off -site borrow and waste areas) 21.17 acres
Amount of fee enclosed $ 6,600
7. Soil Erosion & Sedimentation Plan Filed? Yes V No
8. Landowner(s) of Record (Use blank page to list additional owners)
we
10
The Terraces , LLC
Name
13815 Cinnabar Place
Mailing Address
Huntersville NC 28078
City State Zip
704-875-9704
Telephone Number
Name
Mailing Address
City State Zip
Telephone Number
Indicate Deed Book and Page where deed(s) or instrument(s) are recorded
Deed Book 5127 Page 1670
Deed Book Page
Tax Map No. 3574918105
Lot No.
Page 1

PART B:
1. Person(s) or firm(s) who are financially responsible for this land -disturbing activity
The Terraces, LLC
Name
13815 Cinnabar Place
Mailing Address
Huntersville NC 28078
City State Zip
704-875-9704
Telephone Number
Name
Mailing Address
City State Zip
Telephone Number
2. If the Financially Responsible Party is not a resident of North Carolina, give name and street
aaaress or a North Carolina agent.
Name
Mailing Address Street Address
City State Zip Telephone Number
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 Part is a Corporation give name and street address of the Registered Agent.
Name
Mailing Address Street Address
City State Zip Telephone Number
4. 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 authority to execute instruments for the financially responsible person). I
agree to provide corrected information should there be any change in the information provided
herein. Ad is 'r 06. t&J Oj J�t1sV l+y�L
Ty e or Print Name Title or Authority
Sill nature Date a Notary Public of the County of&ue tate of North
Carolina, hereby ce ify that appeared personally before me this day
and being duly sworn acknowledged that he above form executed by him. e`e`MARY���p��i,,��
Wi s y hand and notari al, this day of 1 2 ci a O . , ,
Notary SEAL My Coin mission Expires qeok�o y Public
File: Financial ResponsibMty2Owners fD)%MW77- 'Inty ?
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