NCC232862_FRO Submitted_20230922

Pitt County
fi cot,' Planning Department
• ?� a Development Services Building
o e 1717 W. 5th Street
,4L
Greenville, North Carolina 27834-1696 James F.Rhodes,AICP
Telephone: [phone]
Fax: [phone] Director
Financial Responsibility/Ownership Form
Soil Erosion and Sedimentation Control Ordinance
No person may initiate any land-disturbing activity on one or more contiguous acres as
covered by the Act before this form and an acceptable erosion and sedimentation control plan
have been completed and approved by the Pitt County Planning Department. (Please type or
print and, if question is not applicable, place N/A in the blank.)
Part A.
1. Project Name Chicod Landing Subdivision - Single Family Homes Construction
2. Location of land-disturbing activity: County Pitt County
City or Township Chicod , and Highway/Street NC Hwy. 43
3. Approximate date land-disturbing activity will be commenced: October 2022
4. Purpose of development(residential, commercial, industrial, etc.): residential
5. Approximate acreage of land to be disturbed or uncovered: 29.9 acres
6. Has an erosion and sedimentation control plan been filed? Yes X No
7. Person to contact should sedimentation control issues arise during land-disturbing activity:
Name Christopher Ahlers Telephone [phone]
8. Landowner(s) of Record (Use blank page to list additional owners):
Jones & Smith Contractors, LLC
Name(s) Name(s)
112 W. Fire Tower Rd.
Current mailing address Street address
Winterville NC 28590
City State Zip City State Zip
9. Recorded in Deed Book No. 4230 Page No. 142
Part B.
1. Person(s) or firm(s) who are financially responsible for this land-disturbing activity (Use
the blank page to list additional persons or firms):
D.R. Horton, Inc. - Central Carolina Div. Tracy Davis
Name of person(s)or Firm(s) Name(s)
7208 Falls of Neuse Rd., Ste 201 7208 Falls of Neuse Rd., Ste 201
Current mailing address Street Address
Raleigh NC 27615 Raleigh NC 27615
City State Zip City State Zip
919-497-2163 919-497-2163
Telephone Telephone

2. (a) If the Financially Responsible Party is a Corporation, give name and street address of
the Registered Agent.
Name(s)
Current mailing address Street Address
City State Zip City State Zip
Telephone Telephone
(b) If the Financially Responsible Party is a Partnership give the name and street address
of each General Partner(Use blank page to list additional partners):
Name(s) Name(s)
Current mailing address Current mailing address
City State Zip City State Zip
Telephone Telephone
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/her 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. ...._r--
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I S i j 2022
Signature b�� � Date
I, ,05W( a Notary Public of the County of(\ n State
of North Carolina, hereby certify that 1�C.,. 1Th S
appeared personally before me this day and being duly sworn acknowledged that the above form
was executed by him.
Witness my hand and notarial s-al this 3) day of\. \%- . 2Q`
.\
Janis Perez Notary (R�
NOTARY PUBLIC My commission expires ctp\' /ac
Johnston County �j
North Carolina
My Commission Expires August 4,2026