NCC217120_FRO Submitted_20211222

FINANCIAL RESPONSIBILITYIOWNERSHIP 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 Land Quality Section, N.C. Department of Environmental Quality. Submit the completed form to the
appropriate Regional Office. (Please type or print and, if the question is not applicable or the e-mail and/
or fax information unavailable, place NIA in the blank.)
Part A. Beach Walk
1. Project Name
2. Location of land -disturbing activity: County Brunswick City or Township Town of Calabash
0
CI
5.
Highway/Street Beach Drive (Hwy 179B) Latitude 33d52'56" Longitude-78d32'47"
Approximate date land -disturbing activity will commence: 1 /1 12022
Purpose of development (residential, commercial, industrial, institutional, etc.): Residential
Total acreage disturbed or uncovered (including off -site borrow and waste areas): 69.7
6. Amount of fee enclosed: $ 4,550 . The application fee of $65.00 per acre (rounded
up to the next acre) is assessed without a ceiling amount (Example: a 9-acre application fee is $585).
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:
Name Walter Warren, PE E-mail Address [e-mail]
Telephone [phone]
cell # 843-458-0583 Fax # N/A
9. Landowner(s) of Record (attach accompanied page to list additional owners):
Julia Wehterington 252-617-7653 NIA
Name Telephone Fax Number
2506 Steeple Chase Drive same
Current Mailing Address Current Street Address
Trent Woods NC 28562
City State Zip City State Zip
10. Deed Book No. 2508 page No.1304 Provide a copy of the most current deed.
Part B.
1. Company(les) or firm(s) who are financially responsible for the land -disturbing activity (Provide a
comprehensive list of all responsible parties on an attached sheet.) If the company or firm is a sole proprietorship,
the name of the owner or manager may be listed as the financially responsible party.
Lennar Carolinas, LLC [e-mail]
Name E-mail Address
1941 Savage Road Same
Current Mailing Address Current Street Address
Charleston SC 29407
City State Zip City State Zip
Telephone [phone] Fax Number

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:
Coporate Creations Network, Inc.
Name E-mail Address
700 NW 107th Ave, Ste 400 15720 Brixham Hill Avenue #300
Current Mailing Address Current Street Address
Miami, FL 33172 Charlotte, INC 28277
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 E-mail Address
Current Mailing Address Current Street Address
City
Telephone
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 be any change in the information provided herein.
Type or
Signaf%re
Title or Authority
Oil I'! 1 L>az i
©ate
I, l t onf U , a Notary Public of the County of N'M cd oo ,
COk
State of h olina, hereby certify that Q4Vf, kAoblty ,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 11 day of 141
Notary
20 1-1
My commission expires k0[lji�1

9_ Landowner(s) of Record (attach accompanied page to list additional owners):
Karen Smalls
Name
15406 SE 1761h PL
Current Mailing Address
Renton, WA 98058
City State
10_ Deed Book No. 4073
206-681 -3012
Telephone
same
Current Street Address
Zip city
N/A
Fax Number
State Zip
Page No_ 1 318 Provide a copy of the most current deed.