NCC223252_FRO Submitted_20220921

RECEIVE
AUG 0 h 2022
FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
EROSION & SEDIMENTATION CONTROL
No person may initiate any land4sturbing activity on one or more acres, '/x acre or more inside a watershed, as covered by the
Sedimentation Pollution Control Act and the Iredell County land Development Code, before this form and an acceptable erosion
and sedimentation control plan have been submitted and approved by the Iredell County Development Services, Planning Dlvlslon-
Erosion Control Section, (Please type or print,)
Fart A.
1. Project Name Summerlin Subdivision
Z Locallon of land -disturbing activity: County Iredell city or Townshlp:Mooresyille
FaokouworMi* U" 35.533834 -80 822664
HlghwaylStreet Latitude l.angitudr3�
3. Approximate date land -disturbing activity will commence: 07/2022
4. Purpose of development (residential, commercial, Industrial, institutional, etc.): Residential
S. Total acreage disturbed or uncovered (including off -site borrow and waste areas): 8.75
6. Amount of fee enclosed: $ ,575 An application fee of $175.00 per acre (rounded up to the next acre) Is
assessed without a calling amount (Example: a 9-acre application fee is $1575). For projects > than .5 acre but a 1,0 acre
In a water supply watershed, a Pat fee of $135.00 Is assessed.
7. Has an erosion and sediment control plan been filed? Yes ^ No^ Enclosed X
8. Person to contact should erosion and sediment control issues arise during land -disturbing activity:
Name Marc Battiste
704-399-4663
Telephone Coll #
F-malt Address [e-mail]
Fax #
9. Landowner(s) of Record (attach accompanied page to list additional owners):
Summerlin 76, LLC 704_-399_-4663
Name Telephone Fax Number
10880 Wilshire Blvd., Suite 1420
Current Mailing Address 1' Current Street Address
Los Angeles CA 90024
City State Zip City State zip
10. peed Book No. 2336 Page No. 2271 Provide a copy of the most current deed.
Fart B.
1. Person(s) or firm(s) who are financially responsible for the land -disturbing activity (Provide a comprehensive list of all
responsible parties on an attached sheet):
Eastwood Constructlon Partners, LLC
Name
2857 Westport Road
Current Malling Address
Charlotte NC 28208
City state zip
Telephone [phone]
[e-mail]
E-mail Address
Current Street Address
Fax Number
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State
Zip

2. (a) If the Financially Respons k.- Party is not a resident of North Carolina, glvi .,me and street address of the designated
North Carolina Agent:
Name
E-mail Address
Current Mailing Address - Current Street Address
City Stale Zip City State Zip
Telephone Fax Number
(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 p -- Fax Number
The Above Informal€on is true and correct to the hest 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 by any change In the Information provided herein.
Marc Battiste Vice President of Construction
7115 :' a .
[dale
a Notary Public of the County of k..teL?'J�t'—A
end being duly sworn acknowledged that the above form was executed . by him appeared personally before ma this day
Stale of North Carolina, hereby cerlif that ._, . Htt1'"G tom, (~ I
,
Witness my hand and notarial seal, this day of L)Ld, 20 � r "
Notary
Seat My commission expires -- 0
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