HomeMy WebLinkAboutNCC230571_FRO Submitted_20230303JOHNSTON COUNTY FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
SEDIMENTATION POLLUTION CONTROL ACT
No person may initiate any land -disturbing activity on one or more acres as covered by the Act before this
form and an acceptable erosion and sedimentation control plan have been completed and approved by the
Johnston County Department of Public Utilities. (Please type or print and, if the question is not applicable or
the e-mail and/or fax information unavailable, place N/A in the blank.)
Part A.
1. Project Name Townes at Tuscany
ii
3.
4.
5.
6.
7.
Location of land -disturbing activity: City or Township Clayton Johnston County
Highway/Street Verona Drive Latitude35.650 Longitude-78.366
Approximate date land -disturbing activity will commence: 2/01/2023
Purpose of development (residential, commercial, industrial, institutional, etc.): Residential
Total acreage disturbed or uncovered (including off -site borrow and waste areas):' 40
Amount of fee enclosed: $380.00 . The application fee of $380.00 per acre (rounded
up to the next acre) is assessed for the first 10 acres and an additional $125 per acre for each
additional acre (rounded up to the next acre). Individual residential lots plans are $100 per lot.
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 E-mail Davis E-mail Addresstmdavisl @drhorton.com
Telephone9194972163
Cell #
Fax #
9. Landowner(s) of Record (attach accompanied page to list additional owners):
42 East LLC 9192913763
Name Telephone
8310 Bandford Way
Current Mailing Address Current Street Address
Raleigh NC 27615
City State
10. Deed Book No.05972
Part B.
Zip City
Page No.0839
Fax Number
State Zip
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):
D.R. Horton INC tmdavisl@drhorton.com
Name
7208 Falls of Neuse Road Suite 201
Current Mailing Address
Raleigh NC 27615
City State
Telephone9194972163
E-mail Address
Current Street Address
Zip City
Fax Number
State
Zip
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
Telephone
E-mail Address
Current Street Address
State Zip City State Zip
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
Current Mailing Address
City
Telephone
E-mail Address
Current Street Address
State Zip City State Zip
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 be any change in the information provided herein.
T p or print n e Title or Authority
1 I 13 1 2oZ
Signature Date
I, rn rnU SCt�ltil �,(S , a Notary Public of the County of
wake_
State of North Carolina, hereby certify that ) �(0.C� V `+ �C�. V\ S appeared
personally before me this day and being duly sworn a knowledged that the above form was
executed by him.
Witness my hand and notarial seal, this
FR..........
�0'CARY �s'•
au�el C� .
f day of VWG_V , 20 0� 3
GYJY�i`� �,WI
Notary j
My commission expires 111