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Home My WebLink AboutNCC233572_FRO Submitted_20231212 JOHNSTON 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 NW-13 Copper Ridge Ph 2 Individual Lots 2. Location of land-disturbing activity: City or Township Flowers Plantation Highway/Street E. Neuse River PKWY.Latitude3 5 . 6 6 3 8 N Longitude 7 8 • 3687 W 3. Approximate date land-disturbing activity will commence:Current 4. Purpose of development (residential, commercial, industrial, institutional, etc.):Residential 5. Total acreage disturbed or uncovered (including off-site borrow and waste areas):2 8 Ac 6. Amount of fee enclosed: $5, 700 . The application fee of$400.00 per acre (rounded up to the next acre) is assessed for the first 8 acres and an additional $125 per acre for each additional acre (rounded up to the next acre). 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: NameAndrew Stocks E-mail Address astocks@stocksengineering. com Telephone252-459-8196 Cell # 1 . 252 . 450 . 5140 Fax# 1 . 252 . 459 . 8196 9. Landowner(s)of Record (attach accompanied page to list additional owners): KL Flower Plantation 1 . 678 . 751 . 8535 252 . 459 . 8197 Name Telephone Fax Number 105 NE 1st St . Same Current Mailing Address Current Street Address Delray Beach, FL 33444-3807 Same City State Zip City State Zip 10. Deed Book No.0 5 3 7 5 Page No.0101 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): True Homes, LLC jcounter@truehomesusa . com Name E-mail Address 2649 Brekonridge Centre Dr. Suite 104 SAME Current Mailing Address Current Street Address Monroe, NC 28110-5632 Same City State Zip City State Zip Telephone 1 . 919 . 645 . 8287 Fax Number 1 . 252 . 459 . 8197 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 E-mail Address Current Mailing Address Current Street Address City State Zip City State Zip Telephone 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: True Homes, LLC jcounter@truehomesusa . com Name of Registered Agent E-mail Address 2649 Brekonridge Centre Dr. Suite 104 SAME Current Mailing Address Current Street Address Monroe, NC 28110-5632 SAME City State Zip City State Zip Telephone 1 . 919 . 645 . 8287 Fax Number 1 . 252 . 459 . 8197 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. Type or print name Title or Authority Signature Date I, , a Notary Public of the County of State of North Carolina, hereby certify that 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 day of , 20 Notary Seal My commission expires 2. (a) If the Financially Responsible Part i designated North Carolina y is not a resident of North Carolina, give a Agent: name and street address Name E-mail Address Current Mailing Address Current Street Address City State Zip City State Zi p Telephone Fax Number (b) If the Financially Responsible assumed name, p sible Party is a Partnership or other person engaging in business under an e, attach a copy of the Certificate of Assumed Name. If the FinanciallyResponsible Party is a Corporation, give name P and street address of the Registered Agent: True Homes , LLC counter@truehomesusa . com Name of Registered Agent E-mail Address 2649 Brekonridge Centre Dr . 'Suite 104 SAME Current Mailing Address Current Street Address Monroe , NC 2 8110 - 5 632 SAME City State Zip City State Zip Telephone 1 . 919 . 645 . 8287 1 . 252 . 459" . 8197 p Fax Number The above information is true and correct to the best of my knowledge and belief and was provided p ed by me under oath (This form must be signed by the FinanciallyResponsible Person if an individual p ual or his attorney-in-fact, or if not an individual, by an officer, director, partner, or 9 registered agent with 9 the authority to execute instruments for the FinanciallyResponsible Person ). I agree r p ) gee to provide corrected information should there be any change in the information provided herein . 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