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HomeMy WebLinkAboutNCC233087_FRO Submitted_20231013 Aik ' �u`tir' HE�DERSo"'_c9ur�rk FINANCIAL RESPONSIBILITY/OWNERSHIP FORM NE-—,_,N couNT," ,: SEDIMENTATION POLLUTION CONTROL ACT No person may initiate any land-disturbing activity on one or more acres as covered by the Act before this form and an acceptable erosion and sedimentation control plan have been completed and approved by Henderson County Site Development Department. (Please type or print and, if the question is not applicable or the e-mail and/or fax information unavailable, place N/A in the blank.) Sign the original form in BLUE INK. Part A. 1. Project Name Hertiage Park (1st Take) 2. Location of land-disturbing activity: County Henderson City Town of Fletcher Highway/Street Rutledge Road Latitude 35.4375 Longitude-82.5186 Property Identification Number(s) PIN's See Attached 3. Approximate date land-disturbing activity will commence: 10/1/23 4. Purpose of development(residential, commercial, industrial, institutional, etc.): Residential 5. Total acreage disturbed or uncovered (including off-site borrow and waste areas):5.54 6. Amount of fee enclosed: $200 . The application fee of$300.00 per acre (rounded up to the next acre) is assessed without a ceiling amount include a$200.00 plan review fee to land disturbance fees. (Example: 8.10 ac= $2,900.00). 7. Has an erosion and sediment control plan been filed? Yes X No Enclosed 8. Person to contact should erosion and sediment control issues arise during land-disturbing activity: Name Debra Green E-mail Address degreen@drhorton.com Telephone 843-455-4995 9. Landowner(s)of Record (attach accompanied page to list additional owners): D.R. Horton, Inc 828-458-8566 Name Telephone 80 Peachtree Road, Suite 200 Current Mailing Address Current Street Address Asheville NC 28E City State Zip City State Zip 10. Deed Book No. Page No. Provide a copy of the most current deed. Part B. 1 Company(ies) or firm(s) who are financially responsible for the land-disturbing activity (Provide a comprehensive list of all responsible parties on an attached sheet.) If the company or firm is a sole proprietorship, the name of the owner or manager may be listed as the financially responsible party. D. R. Horton, Inc degreen@drhorton.com Name E-mail Address 80 Peachtree Road, Suite 200 8025 Arrowridge Blvd Current Mailing Address Current Street Address Asheville NC 28E Charlotte NC 282' City State Zip City State Zip Telephone 843-455-4995 Fax Number 855-793-2347 2. (a) If the Financially Responsible Party is not a resident of North Carolina, give name and street address of the designated North Carolina Agent: Name E-mail Address Current Mailing Address Current Street Address City State Zip City State Zip Telephone (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 name and street address of the Registered Agent: Name of Registered Agent E-mail Address Current Mailing Address Current Street Address City State Zip City State Zip 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 attorney-in-fact, or if not an individual, by an officer, director, partner, or registered agent with the 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. Debra Green City Manager T e or print na a Title or Authority 'UAL. a I�la� Signature Date I, ���� � ,�,q�qa Notary Public of the County of State of , hereby certify that appeared personally before me this day and being duly sworn acknowledged that the above form was executed by him. Witness my hand and notarial seal, this t- day of , 20 Z_3 Eblic . na Notaryy CoVrVssion Expires February 13,2024 My commission expires •— --- Z�