NCC233049_FRO Submitted_20231012

13/07/2023, 12:52 Rowan County
Financial Responsibility/Ownership Form Sedimentation Pollution Control Ordinance
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 Rowan County
Environmental Management Department.
Part A Parcel ID Number
249-169
249-170
249-171
249-172
1. Project Name* _
Archer Ridge
2. Location of land-disturbing activity(Highway/Street)*
Lots 14, 15, 16 & 17 Arrow Point Lane, Kannapolis, Rowan County
Latitude Longitude
35.507330 -80.730360
3.Approximate date land-disturbing activity will be commenced
8-1-23
4. Purpose of development(residential,commercial,industrial,etc.)
Residential -4 new single family homes
5.Approximate acreage of land to be disturbed or uncovered"
2.00
6. Person to contact should sediment control issues arise during land-disturbing (:'ell Phone Number"
activity*
704-453-2700 x 165
Seth Mullis
`this information will be made available on the Rowan County Planning&Development website.
Email Address
[e-mail]
https://www.rowancountync.gov/FormCenter/Print?form ID=96&Preview=YES&Save=False&saved Prog ressl D= 1/3

13/07/2023, 12:52 Rowan County
7. Landowner of Record Landowner of Record
J2 Land Investments, LLC
Name Name
Current Mailing Address Current Mailing Address
6549 Morehead Road
Harrisburg, NC 28075
8. Recorded in Deed Book Number Page Number
1419 325
Parts
1. Person or Firm who are financially responsible for this Person or Firm who are financially responsible for this land-
land-disturbing activity disturbing activity
J2 Land Investments, LLC
Name of Person(s)or Firm(s) Name of Person(s) or Firm(s)
Current Mailing Address Current Mailing Address
6549 Morehead Road
Harrisburg, NC 28075
Phone Number Phone Number
704-453-2700 x 165
a. If the Financially Responsible Party is not a resident of North Carolina,give name and street address of a North Carolina
Agent.
Name of Agent Name of Agent
Current Mailing Address Current Mailing Address
Phone Number Phone Number
https://www.rowancountync.gov/FormCenter/Print?formlD=96&Preview=YES&Save=False&savedProgresslD= 2/3

13/07/2023, 12:52 Rowan County
b. 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 Party is a Corporation,give the name and street
address of the Registered Agent.
Name of Registered Agent
Current Mailing Address Current Street Address
Telephone Number Telephone Number
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 correctional information should there be any change in the information provided herein.
Name Title or Authority
J2 Land Investments, LLC by GENCAP Holdings, LLC,Member
Andrew Waltz GENCAP Holdings, LLC by JL Equity 1, LLC Authorized Rep.
JL Equity 1,LLC by Joshua P.Collins Member
Signature Date
©®A
I, A1t A D. g e. ,a Notary Public of the County of C.4110 State of North Carolina,
hereby certify thatappeared personally before me this day and being duly sworn acknowledged
that the above form was executed by him/her.Witness my hand and seal of Notary,this 21 day of Sykk ,203..
Notary lily commission expires J
AeliteA.X. 61/5/2/21
Seal
ALLYSON D. EVERAGE
•
NOTARY PUBLIC
Cabarrus County
North Carolina
My Commission Expires September 18,2027
https://www.rowancountync.gov/FormCenter/Print?formID=96&Preview=YES&Save=False&savedProgressID= 3/3