NCC215947_FRO Submitted_20211027

FINANCIAL RESPONSIBILITY/OWNERSHIP STATEMENT
As per 15A NCAC 04B .0118 — The draft Erosion and Sediment Control Plans will not be approved until
an authorized statement of financial responsibility and ownership is submitted.
As per GS 113A-54.1(a) - If the applicant is not the owner of the land to be disturbed, the owner's written
consent for the applicant to submit a draft Erosion and Sediment Control Plan and to conduct the
anticipated land -disturbing activity must be submitted with this document.
PART A.
Project Name Waterford Springs, Lots 1-42
Location of land -disturbing activity: City High Point
Highway/Street (terminus of existing) Village Springs Dr
Approximate date land -disturbing activity will commence: 08/25/2021
4. Purpose of development (residential, commercial, industrial, etc.)
Residential
5. Approximate acreage of land to be disturbed or uncovered: 5.04 Ac.
6. Has an erosion and sedimentation control plan been filed? Yes X No
7. Landowner(s) of Record (use blank page to list additional owners):
DR Horton, Inc.
Name Name
2000 Aerial Center Parkway, Suite 110
Current Mailing Address Current Mailing Address
Morrisville, NC 27560
City, State, Zip City, State, Zip
[phone]
Telephone Number Telephone Number
8. Indicate book and page where deed or instrument is filed (use blank page to list additional deeds or
instruments):
Book 8495 Page 76
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Page
FinResFm. Page 4 1

PART B.
1. Person(s) or firm(s) who are financially responsible for this land -disturbing activity:
DR Horton, Inc.
Name
Name
2000 Aerial Center Parkway, Suite 110
Current Mailing Address
Current Mailing Address
Morrisville, NC 27560
City, State, Zip
City, State, Zip
[phone]
Telephone Number
Telephone Number
2. Registered agent, if any, for the person or finn who
is financially responsible:
Signature
Mailing Address
Printed Name
Telephone Number
3. 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 if not an individual, by an officer, director, partner or attorney -in -fact, or registered
agent with authority to execute instruments for the financially responsible party.). I agree to
provide corrected information should there be any change in the information provided herein.
Jexg; ca MPY9�_
Type or Print Name
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Title of Authority ka
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Date
I, __ NV5�� Y ,.�, -1 o v,r,q, a Notary Public of the County of c , State of North
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Carolina, do hereby certify that U effi t� Ct V � ,t to ( appeared personally before me
this day and being duly sworn acknowledged that the above form was executed by him.
Nµpu4uen....«`
Witness my l�" SKYOR94N seal, this h day of"L'tu, 20�.
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Notary
County
MY COMM- Exp. My commission expires: f
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FinResFm. Page 4 2