NCC230604_FRO Submitted_20230308

FINANCIAL RESPONSIBILITY OWNERSHIP (FRO) FORM j*;mjjl'Me
Soil Erosion and Sedimentation Control Ordinance NORTIT .CAROLINA
PART B FRO AND NC REGISTERED AGENT
1. Person(s), firm(s) or Company who is/are financially responsible for this land -disturbing activity.
2.
(1 apptzc0110 Norman Lofts, LLC I luontact -Name.I Paul Poteet
Mailing Address.; i875 S State St STE 1400
city Orem state UT z� 84097
Phone. [phone] Entail [e-mail]
If the Financially Responsible Party listed above does not reside. in the state of North Carolina, they must
provide a designated North Carolina agent below. This agent must be registered with/on the NC Secretary of
3. (Optional] Additional contact familiar with the site, who understands the plans, and may represent the company.
S�te:Coritac>E's Name ` Email
Phone, Office; Phone: Mobile
PART C — SIGNATURE WITNESSED BY A NOTARY PUBLIC
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. If the
Financially Responsible Owner is not an individual, this form must be signed by an officer, director, partner, or
registered agent with the authority to execute instruments for the Financially Responsible Parry). I agree to provide
corrected information should there be any change in the information provided herein.
Printed Name Title or Authority f�i—.:•��� J
Wet -Ink Signature — Date
I [;r , Larks r a Notary Publicofthe County ofykl t-\
State of hereby certify that 1 mil, l Q rO�C�.� personally
appeared before me this day and being duly sworn acknowledged that the above'form was executed by him/her.
Witness my hand and notarial seal, this d-1�8, day of QL{� C 20
Ethan William Larkin
Notary Rublio, state or Utah Notary Signature
' commission # 127582
My commission Expires on 1012612026
M Commission Expires
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FINANCIAL RESPONSIBILITY OWNERSHIP(FRO) FORM
Soil Erosion and Sedimentation Control Ordinance NORTH CAROLiNA
Instructions: No person shall initiate any land -disturbing activity on one or more acres, as covered in the Town of
Huntersville Soil Erosion and Sedimentation Control Ordinance, before this form and an acceptable erosion and
sedimentation control plan have been completed and approved by the Town of Huntersville. The Financially
Responsible Party will be on record as the party to accept any Notices of Violation or related documents for any non-
compliance of the Town of Huntersville Soil Erosion and Sedimentation Control Ordinance. If the Financially
Responsible Party resides out of state, a North Carolina agent must be assigned. All items on this form must be
filled out accurately and completely.
PART A — PROJECT AND LANDOWNER INFORMATION
1. Project name
2. Address of land -disturbing activity (number, street)
3. Approximate date land -disturbing activity will begin
4. Purpose of development (Commercial, Residential,
Industrial, etc.)
5. Total acreage of land to be disturbed or uncovered
6. Total site acreage
Norman Lofts
14801 States Rd
March 6th, 2023
Multifamily
2
2,0002
7. Landowner (s) of Record. The names listed below must match the Deed(s). Attach a list of additional owners, if
applicable.
Note: If the landowner of record is not the person(s) firm(s), or Company's Financially Responsible Party,
as listed in Part B, item 1, a separate Letter of Consent, signed and dated by the Landowner of
Indicate the Deed Book and Page number where the deed or instrument is fled. Attach a list of additional deeds
if applicable.
Deed Book Page
Deed Book Page
Deed Book Page
29893
597
Rev. 812022 TOH Staff Reviewer Ownership/Agent: Verified at Pre -Con Meeting By: Pagel of 2