NCC230172_FRO Submitted_20230120

FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
EROSION & SEDIMENTATION CONTROL
No person may initiate any land -disturbing activity on one or more acres, 'Y2 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 Logan Farms Subdivision
2. Location of land -disturbing activity: Countylredell
City or Township Mooresville
Highway/Street W Park Avenue Latitude 35°36'1.10"N Longitude 80°47'35.71"W
3. Approximate date land -disturbing activity will commence: 2/1/2023
4. Purpose of development (residential, commercial, industrial, institutional, etc.): Residential
5. Total acreage disturbed or uncovered (including off -site borrow and waste areas): 38 Acres
6. Amount of fee enclosed: $ 6,650 . 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.
X
7. Has an erosion and sediment control plan been filed? Yes No Enclosed
8. Person to contact should erosion and
and sediment control issues arise during land -disturbing activity:
NametManwu(� YV _ E-mail Address �� (�1 WMwq (-w• W
Telephone i Cell ##✓6(0' �qq -S(o U 8 Fax #
9. Landowner(s) of Record (attach accompanied page to list additional owners):
Allen & Connie Brawley 704-334-0078
Name Telephone Fax Number
601 West Park Avenue
Current Mailing Address Current Street Address
Mooresville NC 28115
City State Zip City State Zip
10. Deed Book No. 698 Page No. 690 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):
�b�c'2,tilRt(VSt, I>�In�.�-� r�� 3, PRuAhesl
Name �� E-mail Address
Current Mailing Address Current Street Address
ftTJ �1C'.W AIL N C_� 9-1 l I -1 CA aC
City State Zip tlty State Zip
Telephone '1V — q q-A S (Q 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
W
(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
Current Mailing Address
E-mail 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.
Emma �,�u, � � s t&Ke( coy ,cn�
Type or print name Title or Authority " 2
Signature Date
I, AejLer -1. a Notary Publicof the County of Mee'lae ,6_r(A
State of North Carolina, hereby certify that Enft&' BoJe5 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 Skin day of 9 n 2.
ry
Seal
isHEATHER J ACKERMANN
Notary Public, North Carolina
Mecklenburg County
My Co mi si L?-9 Aires
My commission expires q I 2DZ6
Page 2 of 2

APPENDIX A
9. Landowner(s) of Record (attach accompanied page to list additional owners):
Doolittle Farms, LLC.
Name Telephone Fax Number
PO BOX 1067 PO BOX 1067
Current Mailing Address Current Street Address
Mooresville NC 28115 Mooresville NC 28115
City State
10. Deed Book No. 1013
Page
Zip City State Zip
No. 375 Provide a copy of the most current deed.

APPENDIX B
9. Landowner(s) of Record (attach accompanied page to list additional owners):
Allen M. Brawley
dame Telephone Fax Number
601 W Park Ave 601 W Park Ave
Current Mailing Address Current Street Address
Mooresville NC 28115 Mooresville NC 28115
City State Zip City State Zip
10. Deed Book No. 1543 Page No. 1764 Provide a copy of the most current deed.