NCC230892_FRO Submitted_20230330

FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
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 Mooresville Auto Park
2. Location of land -disturbing activity: County Iredell City or Township Mooresville
Highway/Street McCrary Road Latitude N 35-36-06 Longitude W 80-54-34
3. Approximate date land -disturbing activity will commence: Spring 2023
4. Purpose of development (residential, commercial, industrial, institutional, etc.): Commercial
5. Total acreage disturbed or uncovered (including off -site borrow and waste areas): 12.3 Ac.
6. Amount of fee enclosed: $ 2,275 . An application fee of $175.00 per acre (rounded up to the next acre) is
assessed without a ceiling amount (Example: a 9-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 $135.00 is assessed.
7. Has an erosion and sediment control plan been filed? Yes No Enclosed X
8. Person to contact should erosion and sediment control issues arise during land -disturbing activity:
Name Brian Lloyd E-mail Address [e-mail]
Telephone [phone] Cell # [phone] Fax #
t
Landowner(s) of Record (attach accompanied page to list additional owners):
Lloydco, LLC [phone]
Name Telephone Fax Number
8282 Luckey Point Road 8282 Luckey Point Road
Current Mailing Address Current Street Address
Denver NC 28037 Denver NC 28031
City State Zip City State Zip
10. Deed Book No. Page No. 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):
Lloydco, LLC [e-mail]
Name E-mail Address
8282 Lucky Point Road 8282 Lucky Point Road
Current Mailing Address Current Street Address
Denver NC 28037
City State Zip
Telephone [phone]
Denver NC 28037
City State Zip
Fax Number
Page 1 of 2

, a) if the Financially ResponsUe Party is not a resident of North Carolina, give name and street address of the designated
North Caro4ina Agent
Name
E-mail dress
Cu"rrt Mailing Address ..�.e� Current Street Address
City ate Zip city state zip
Telephone Fax Number
(d) if the Financially Resppnsible Party is a Partnership or other won engaging in € usin a under an assumed narne, attach
a copy of the Certificate crf Assumed Name. if the Financially Responsible Party is a Corporation, give narne and street
address of the Register Apt
Bran Lloyd 1lo1 964Cag maii.c m
lame of Registered Agent $Wi[ Address
8282 Luckey Point Road 8282 Luckey Pinint Road
Current Mailing ldress Current Street Address
Dearer fir, Qng Denver NO 28037
City _ Mate lip Gfty gib Zip
Telephone—f4l
..4-L282-012 Fax Number
The above it ormatitrn is true and Gorrect to the best of my kwMedge and belief and was provided by me under oath (This form
must be signed by the FInanufally Responsible Peron if an individual or his attorr -in-fad �r of not an irrdl�idu�E, art officer,
director, partner, or registered agent ith tine aruthority to a cute i struments for the Financially Responsib Verson). 1 agree to
pride corrected irrtom�ation should there by any c range in the informatlan provided herein -
Brian rian Lloyd a Principal
Type or print name 'title or Authority
v.
Signature - " Date
i,FO. s_ a--tx .. . � , a Notary Pubk of the Courtly of ��J C
Efate of North an -Ana, hereby eartify that B - a appeared # onafly before one this day
and being duly sin a€ noVe�dged that the ab foray s erec t d b ham_
litrress my hand and notarial seal, this of
Seal
ittytl
y GOMMiSSIOn e ires ' f� a --
'age 2 of