NCC216037_FRO Submitted_20211101

PLAN REVIEW/FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
CATAWBA COUNTY CODE OF ORDINANCES, CHAPTER 16 ARTICLE V
SOIL EROSION AND SEDIMENTATION CONTROL
No person may initiate any land -disturbing activity on one or more acres as covered by the Ordinance before this form
and an acceptable erosion and sedimentation control plan have been completed and approved by the Catawba County
Utilities and Engineering Department. (Please type or print, and if question is not applicable, please N/A in the blank)
PART A �6p2- &) - 20 Z/ -- 3910c
1. Job Name ISherrills Stream (-o+s 3 _3 y
2. PIN or 911 Address q (¢ p C) a.8 51 y ,-� y
3. Purpose of development (residential, commercial, industrial, institutional,etc.) Residential
4. Approximate soil disturbance date November 2021
5. Total acreage disturbed or uncovered (including off -site borrow and waste areas),
6. Has an erosion and sedimentation control been filed? j-" yes r No R Attached
7. If you have an Erosion Control billing account, would you like this to be billed? r- yes r No
Account Number
PEOPLE
S. Person to contact should erosion and sediment control issues arise during land -disturbing activity
Name George Bartley Carroll E-mail address [e-mail]
Telephone l
704-620-7373 Cell # SAME Fax #
9. Landowner(s) of Record (attach accompanied page to list additional owners)
Name .R. Horton, Inc. Telephone Fax #
Current Mailing Address 18025 Arrowridge Blvd
City harlotte State
Current Street Address
City State
10. Deed Book No. Page No. I
FC Zip 28273
Zip
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 attached sheet);
Name George Bartley Carroll (D.R. Horton, Inc.) E-mail address [e-mail]
Current Mailing Address 8025 Arrowridge Blvd
City Fharlotte State NC Zip F28273

Current Street Address
City State Zip
Telephone Fax #
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 CT Corp E-mail address [e-mail]
Current Mailing Address I150 Fayetteville Street
City Raleigh State
Current Street Address
City I State
Zip 27601
Zip
Telephone Fax #
2. (b) If the financially responsible party is a Partnership or other person engaging in business under 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 N/A E-mail address
Current Mailing Address
City State
Current Street Address
City State
Telephone
Zip
Zip
Fax #
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 financialIy 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.
,aGr�leire l r' %0/>CS
Type Print N rie Title of Authority
/o g Za2
Signature Date
Mal,- CC t P S , a Notary Public of the County of 6 aS tD n State of North
Carolina, hereby certify that G e.Cti- {36t�-+ leci Ccc. -v-0'1( appeared personally before anc this day and being duly
sworn acknowledge that the above fodn was executed 6y him.
Witness my hand and notary seal, this IS day of e 2021.
Seal - �cc �•c1t Q Vy) Ck L~Lt.c
Rachel Martin Hayes
NOTARY PUBLIC Notary
Gaston County My Commission expires (( 2'7 2-DV5
North Carolina
My Commission Expires May 27. 2025 Print Form