NCC221095_FRO Submitted_20220318

Town of Huntersville
T' e
Soil Erosion & Sedimentation Control Ordinance
NORTH CAROLINA Financial Responsibility/Ownership Form
No person shall initiate any land -disturbing activity as defined in the Town of Huntersville Soil
Erosion and Sedimentation Control Ordinance prior to completing and filing this form with the Town
of Huntersville. The financially responsible party will be on record as the party to receive any
Notices of Violation or related documents related to non-compliance issues with the above
Ordinance. By filing this form, the parties are not relieved from any other permits that may be
required for the Project. if the financially responsible party is out of State, a North Carolina agent
must be assigned.
Please Type or Print
PART A
1. Project where land -disturbing activity is to be undertaken: North Creek Village - Residential
2. Address of land -disturbing activity: 13552 Sam Furr Rd, Huntersviile , NC 28078
Huntersville, NC 28078
3. Approximate date land -disturbing activity will commence: March 21 2022
Month Day Year
4. Purpose of development (Residential, Commercial, Industrial, etc.): Residential
5. Approximate acreage of land to be disturbed or uncovered. 30
6. Total site acreage: 41.34 AC
7. Landowners of record (use blank pages to list additional owners as necessary)
Owner #1 Name: CND -North Creek, LLC
Address: 1111 North Post Oak Rd, Houston, TX 77055
Telephone: [phone] Fax:
Email Address: [e-mail]
Owner #2 Name:
Address:
Telephone:
Email Address:
Fax:
8. Indicate Book and Page where the deed or instrument is filed (use blank pages to list
additional deeds or instruments as necessary)
Book 36731 Page 115 Book Page
Book Page Book Page

Financial Responsibility/Ownership Form - Continued
PART B
Person(s) or firm(s) financially responsible for this land -disturbing activity:
Persons or Firm: CND -North Creek, LLC (Contact: Scott Kilby)
Address: 111 1 North Post Oak Road, Houston, TX 77055
Telephone: [phone]
Email Address: [e-mail]
Fax:
2. North Carolina agent for the person or firm who is financially responsible:
Person or Firm: Corporation Service Company
Address: 2626 Glenwood Avenue, Suite 550 Raleigh, NC 27608
Telephone: [phone]
Email Address:
Fax:
3. The above information is true and correct to the best of my knowledge and belief and was
provided by me while under oath. (This form must be signed by the financially responsible
person is an individual or by an officer, director, partner, attorney -in -fact, or other person
with authority to execute instruments for the financially responsible company or entity, if not
an individual)
Scott Kilby
Printed Name
9
Title
Date
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a Notary
Public of the County of Ug un , State of Ci hereby
certify that Scar fit) by personally appeared
before me on this day and under oath acknowledged that this form was executed by him/her.
Witness my hand and,notarial seal, this I q *� day of _HU(CV) , 20 d? L
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Notary Signature:
My Commission Expires:
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Town of Huntersville
PO Box 664
105 Gilead Rd., Ste 300
Huntersville, NC 28070