NCC215442_FRO Submitted_20210930

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 Iredeil County Planning & Development, Erosion Control Section.
(Please type or print.)
Part A.
1. Project Name Greenbriar - Statesville
2. Location of land -disturbing activity: County Iredeil City or Township Statesville
Highway/Street S. Greenbriar Road Latitude 35.79337 Longitude-80.83079
3. Approximate date land -disturbing activity will commence: 10/0412021
4. Purpose of development (residential, commercial, industrial, institutional, etc.): Residential
5. Total acreage disturbed or uncovered (including off - site borrow and waste areas): 36.82
6. Amount of fee enclosed: $ 6,475 (previously paid) . 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 X No Enclosed
8. Person to contact should erosion and sediment control issues arise during land -disturbing activity:
Name Joel Causey, PE 1 Lennar E-mail Address [e-mail]
Telephone [phone] Cell # 704-607-8381 Fax # NIA
9. Landowner(s) of Record (attach accompanied page to list additional owners):
Lennar Carolinas, LLC 704-309-1425
Name Telephone Fax Number
6701 Carmel Road, Suite 425
Current Mailing Address Current Street Address
Charlotte NC 28226
City State Zip City State Zip
10. Deed Book No. 2850 Page No. 1 732 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):
Lennar Carolinas, LLC [e-mail]
Name E-mail Address
6701 Carmel Road, Suite 425 6701 Carmel Road, Suite 425
Current Mailing Address Current Street Address
Charlotte NC 28226 Charlotte NC 28226
City State Zip City State Zip
Telephone [phone] Fax Number N/A
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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:
Name of Registered Agent
Current Mailing Address
City
Telephone
E-mail Address
Current Street Address
State Zip City
Fax Number
State Zip
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 by any change in the information provided herein.
Mark Henninger Division President
Type or printDpme
Title or Authority
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I, C.CLVJJ C! 1 tIrdii�. V&t a Notary Public of the County of
State of North Carolina, hereby certify that H (J iV, I+Wth-1 V.G1 appeared personally before me this day
and being duly sworn acknowledged that the awl ove form was executed him.
Witness my hand and notarial seal, this ! S day of
Seal
CANDIDA PERDOMO
Notary Public - North Carolina
Union County
My Commission Expires Nov 18, 2023
e 20 2.
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My commission expires 6j I Y, ab 9.3
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