NCC232991_FRO Submitted_20231009

O°it� Gaston County
l'Wt Gaston Natural Resources Department
1303 Cherryville Highway, Dallas, NC 28034 Telephone: [phone]
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*kaRa4 A So Erosion & SecoHimentati��n Control
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y Financial Responsibllllty/Ownership
,`7.°AniLnt***
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 Soil 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 N/A in blank)
PART A:
1. Project Name S New Hope Rd Commercial
2. Location of land-disturbing activity
City Gastonia Highway/Street S New Hope Rd
3. Approximate date land-disturbing activity will commence 9/1/2023
4. Purpose of development(residential, commercial, industrial, etc.) Commercial
5. Total acreage disturbed or uncovered (including off-site borrow and waste areas) 3.6
6. Amount of fee enclosed $1600
7. Soil Erosion &Sedimentation Plan Filed? Yes X No
8. Landowner(s)of Record (Use blank page to list additional owners)
New Hope Rd LLC
Name Name
371 Lorraine Rd
Mailing Address Mailing Address
Fort Mill SC 29708
City State Zip City State Zip
803.280.4809
Telephone Number Telephone Number
9. Indicate Deed Book and Page where deed(s)or instrument(s)are recorded
Deed Book 5300 Page 1690
Deed Book Page
10. Tax Map No. 148691, 148692, 148693,201932 Block Lot No.
Page 1

PART B:
1. Person(s)or firm(s)who are financially responsible for this land-disturbing activity
New Hope Rd LLC Balaji Tatineni
Name Name
371 Lorraine Rd 371 Lorraine Rd
Mailing Address Mailing Address
Fort Mill, SC 29708 Fort Mill, SC 29708
City State Zip City State Zip
803.280.4809 803.280.4809
Telephone Number Telephone Number
2. If the Financially Responsible Party is not a resident of North Carolina, give name and street
address of a North Carolina a ent.
Venkatrao Vardineni
Name
6424 DONNEGAL FARM RD
Mailing Address Street Address
Charlotte NC 28270 248.808.3639
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 he 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.
i3 A-LAB t `T'Tk N N l 1'l A-to►''' i N(t
Type or Print Name Title or Authority
Signature Date
I, ISrAykv4 Loo✓ , a Notary Public of the County of Vu.2cttle,.►Uu , State of North
Carolina, hereby certify that gala j', ''ra+iv\e n� 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 1\ day of ZU1� , 2cZ3 . My Commission Expires
n,+u ,,, June 19 2026
Notary— L 0,9'1Jy Commission Expires
aOTA/�) a File:Financial Responsibility-Ownership Form.mw
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