NCC223677_FRO Submitted_20221028

FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
IR-S EROSION & SEDIMENTATION CONTROL
No person may initiate any land -disturbing activity on one or more acres, '/2 acre or more inside a
watershed, as covered by the Sedimentation Pollution Control Act and the Iredell County Land
Development Code, before an acceptable erosion and sedimentation control plan has been submitted
and approved by the Iredell County Planning & Development, Erosion Control Section.
(Please type or print)
Part A.
1. Project Name Shepherds Landing Phase 1
2. Location of land -disturbing activity: County Iredell City or Township Mooresville
Vaquaro Dr./Guardian 35.633120 80.824220
Hig hway/Street Gate. L r _ ^ Latitude Longitude
3. Approximate date land -disturbing activity will commence: 6/30/2022
4. Purpose of, development (residential, commercial, industrial, institutional, etc.): Residential
5. Total acreage disturbed or uncovered (including off -site borrow and waste areas): 4.9 Acres
6. Amount of fee enclosed: $ 875.00 . An application fee of $175.00 per acre (rounded up to the next acre) is
assessed without a ceiling amount (Example: a 8.10-acre application fee is $1575). For projects > than 0.5 acres but no
greater than 0.99 acres in a water supply watershed, a flat fee of $100.00 is assessed.
7. Has an erosion and sediment control plan been filed? Yes No Enclosed
8. Person to contact should erosion and sediment control issues arise during land -disturbing activity:
Name Patrick Zukowski E-mail Address [e-mail]
Telephone_ _ Cell # 704 989 0731 Fax #
9. Landowner(s) of Record (attach accompanied page to list additional owners):
Meritage Homes of the Carolinas, Inc.
704 944 8900
Name
Telephone Fax Number
13925 Ballantyne Corporate Place Suite 300
13925 Ballantyne Corporate Place Suite 300
Current Mailing Address
Current Street Address
Charlotte NC 28277
Charlotte NC 28277
City State Zip
City State Zip
10. Deed Book No. 2764 Page No. 108
Provide a copy of the most current deed.
Part 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):
Meritage Homes of the Carolinas, Inc
[e-mail]
Name
E-mail Address
13925 Ballantyne Corporate Place Suite 300
13925 Ballantyne Corporate Place Suite 300
Current Mailing Address
Current Street Address
Charlotte NC 28277
Charlotte NC 28277
City State Zip
City State Zip
Telephone [phone]
Fax Number_
Page 1 of 2

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
Current Mailing Address
City State
Telephone
E-mail Address
Current Street Address
Zip City State
Fax Number
Zip
(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 _ Fax 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 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.
Type or rint name 1 Title or Authority
Signature Date
I, �_r�_ • �Q—�d�� _ a Notary Public of the County of M �C�•-�t�...�J(�,�°�
State of North Carolina, 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 � day of S 0 Z
Nota r
�' F#�;�,��i�My commission expires Z' Z• Z 5
100TARY
PUBL�O
CS
Page 2 of 2

Meritage Homes of the Carolinas Inc Vendor 687199
County of Iredell Check No. 70540490
Invoice Purchase PO Date Account/Job BU/CostCode
_Address_ Order Suffix Description/Remark
SEE ATTACHMENTS
FORM R5504578 V10 09121
Date 07/14/22 Amount $875.00
Gross
Amount
Adjusts Net
Amount
Please Detach Before Presenting for Payment Meritage Homes of the �Caronas fnc * Carol Check No.
�ntaae 13925 Ballantyne Corp: Place, Suite 300 64.1279. GA
70540490'
Homes
Charlotte NC 28277 -6tr
Home (i Bank of Amed6
lJ\ [phone] 07/14/22
C O R P O R A T 1 0 N
PAY EIGHT HUNDRED SEVENTY FIVE. AND
$*******875.00
Meritage Homes of the Carolinas Inc
To County of7Iredell TWO SIGNATURES REQUIRED IF OVER $100,000
The P O Box 88
Order Statesville NC 28687 Of
VOID After 90 Days
111?054049011' 1:061 L 1 2M131: 33S9480S7Lam

COUNTY OF IREDELL (PERMITS)
Invoice Purchase Order Date Account/Job BU/CostCode
Address Number/Suffix/L Description/Remark
EROSIONCONTROLPHASE1 07/14/22 70552119950.12640.10320
Shepherds Landing Design & Plan Review Fees
Payment Total
Meritage Homes of the Carolinas Inc
Vendor 687199 Check # 70540490 Date 07/14/22 Amount
Gross Adjusts
Amount
875.00
875.00
$875.00
Net
Amount
875.00
875.00
Payment Attachment FORM R550457C V02 09/19 Page 1 of 1