NCC230431_FRO Submitted_20230215

Gaston County
X Gaston Natural Resources Department
1303 Cherryville Highway, Dallas, NC 28034 Telephone: [phone]
a_ Soil Erosion & Sedimentation Control
Financial Responsibility/Ownership
No person may initiate any land -disturbing activity on one (1) or more acres of property in all portions of
Gaston County, except for that property within the city limits of the incorporated municipalities of Gaston
County who have not adopted the Gaston County Sail Erosion & Sedimentation Control Ordinance,
before this form and an acceptable Soil Erosion & Sedimentation Control Plan have been completed and
approved by the Gaston County Natural Resources Department's staff.
(Please type or print and, if question is not applicable, place NIA in blank)
PART A:
1. Project Name Villages at Qramertoa Mills Phase 3E —
2. Location of land -disturbing activity
City _ Cram-erton HighwayiStreet Cramer Mountain Rd and S. New Hoe Rd
3. Approximate date land -disturbing activity will commence 12/2022
4. Purpose of development (residential, commercial, industrial, etc_) Future Commercial
5. Total acreage disturbed or uncovered (including off -site borrow and waste areas) 1.64 Ac.
6. Amount of fee enclosed $ 600
7. Soil Erosion & Sedimentation Plan Filed? Yes No
M
�7
10
i anrlownerlsl of Record (Ilse blank page to list additional owners)
NEW HOPE REAL EST INVESTMT LLC
Name
200 Keyhole Ct
Mailing Address
Cramerton NC 28032
City State Zip
7Q4-254-3137 _
Telephone Number
Name
Mailing Address
City State Zip
Telephone Number
Indicate Deed Book and Page where deed(s) or instrument(s) are recorded
Deed Book 4231 Page 2018
Deed Book Page
Tax Map No. 196081 Block
Lot No.
Page 1

PART B:
f. Person(s) or firm(s) who are financially responsible for this land -disturbing activity
New Hope Real Estate Investments LLC
Name
200 Keyhole Ct. _
Mailing Address
Cramerton NC 28032
City State Zip
704-747-3448
Telephone Number
Name
Mailing Address
City State Zip
Telephone Number
2. If the Financially Responsible Party is not a resident of North Carolina, give name and street
aaaress of a North uarollna
Name
Mailing Address Street Address
City State Zip Telephone Number
3. 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 Part is a Corporation give name and street address of the Registered Agent.
Name
Mailing Address Street Address
City State Zip Telephone Number
4. 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 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. �y y�
Type or Print Nanhe Title or Authori
Signature ki Date
I,U4 i I j LAJLL7� a Notary Pjiiblic of the County ofState of North
Carolina, hereby certify tha 1 appeared personally before me this day
and being duly sworn acknowledge that ft above form was executed by him.
Witness my hand and notarial seal, this day of AAn., r, AAA 2h-3-'k .
r ptary- SEAL My Commission Expires
File: Financial Responsibility -Ownership Form.mw
KA T HLEEN GILLETT'E
Notary Public
Gaston Co., North Carolina
My Commission Expires Oct. 29, 2024
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