NCC216458_FRO Submitted_20211119

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Town of Huntersville
,� Soil Erosion & Sedimentation Control Ordinance
Financial Responsibility/Ownership Form
No person shall initiate any land -disturbing activity as defined in the Town of Huntersville Soil
Erosion and Sedimentation Control Ordinance prior to completing and filing this form with the Town
of Huntersville. The financially responsible party will be on record as the party to receive any
Notices of Violation or related documents related to non-compliance issues with the above
Ordinance. By filing this form, the parties are not relieved from any other permits that may be
required for the Project. If the financially responsible party is out of State, a North Carolina agent
must be assigned.
Please Type or Print
PART A
1. Project where land -disturbing activity is to be undertaken: Walden - Individual Lots
Lots 56, 151-159, 214-217, 223, 226, 230, 241, 247-250, 360-365
2. Address of land -disturbing activity: Multiple
3. Approximate date land -disturbing activity will commence: 09
Month
4. Purpose of development (Residential, Commercial, Industrial, etc.):
5. Approximate acreage of land to be disturbed or uncovered: 4.64 ac
6. Total site acreage: 4.64 ac
01 2021
Day Year
Residential
7. Landowners of record (use blank pages to list additional owners as necessary)
Owner #1 Name: Taylor Morrison of Carolinas, Inc.
Address: 11405 N Community House Rd, Suite 150
Charlotte, NC 28277
Telephone: [phone]
Email Address: [e-mail]
Owner #2 Name:
Address:
Telephone
Email Address:
Fax: N/A
Fax:
8. Indicate Book and Page where the deed or instrument is filed (use blank pages to list
additional deeds or instruments as necessary)
Book 65 page 621 Book 68
Book 68 page 989/990
11/19
Book
Page 147
Page

Financial Responsibility/Ownership Form - Continued
PART B
Person(s) or firm(s) financially responsible for this land -disturbing activity:
Persons or Firm: Taylor Morrison of Carolina, Inc
Address: 11405 Community House Road, Suite 150
Charlotte, NC 28277
Telephone: [phone]
Email Address: [e-mail]
Fax: N/A
2. North Carolina agent for the person or firm who is financially responsible. -
Person or Firm: Tom Johnson
Address: 11405 Community House Road, Suite 150
Charlotte, NC 28277
Telephone
704-357-6632
Email Address: [e-mail]
Fax: N/A
3. The above information is true and correct to the best of my knowledge and belief and was
provided by me while under oath. (This form must be signed by the financially responsible
person is an individual or by an officer, director, partner, attorney -in -fact, or other person
with authority to execute instruments for the financially responsible company or entity, if not
an individual)
Tom Johnson
Printed Name
Siarrature
Vice President of Land Development
Title
Date
,,.. [r a Notary
Public of the County of r State of �v­(jo Qmn�l I hereby
certify that personally appeared
before me on this day and under oath acknowledged that this form was executed by him/her.
Witness my hand and notarial seal, this [ day of �,r� r , 20.
Notary Signature:
CZ
My Commission Expires:
Town of Huntersville
PO Box 664
105 Gilead Rd., Ste 300
Huntersville, NC 28070
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