NCC220224_FRO Submitted_20220112

FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
EROSION & SEDIMENTATION CONTROL
No person may initiate any land -disturbing activity on one or more acres, '/ 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 Iredell County Planning & Development, Erosion Control Section.
(Please type or print.)
Part A.
1. Project Name Sullivan Farm
2. Location of land -disturbing activity: County Iredell City or Township Statesville
HighwaylStreet James Farm Road Latitude 35.8276826 Longitude-80.8642881
3. Approximate date land -disturbing activity will commence: January, 2022
4. Purpose of development (residential, commercial, industrial, institutional, etc.): Residential
5, Total acreage disturbed or uncovered (including off -site borrow and waste areas): 88.46
6. Amount of fee enclosed: $ 15,575 . 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 No Enclosed XXX
8. Person to contact should erosion and sediment control issues arise during land -disturbing activity:
Name Joel Causey E-mail Address [e-mail]
Telephone [phone] Cell # 704-607-8381 Fax #
a
Landowner(s) of Record (attach accompanied page to list additional owners):
Logsdon & Neece, PLLC 336-667-2526
Name Telephone
906 Main Street, Suite 101
Fax Number
Current Mailing Address Current Street Address
North Wilkesboro, NC 28659
City State Zip City State Zip
10. Deed Book No. 2780 Page No. 303 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
Current Mailing Address Current Street Address
Charlotte, NC 28226
City State Zip City State Zip
Telephone [phone] Fax Number
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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
Current Mailing Address
City State
Telephone
E-mail Address
Current Street Address
Zip City
Fax Number
State Zip
(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
Type or print namy
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State of North Carolina, hereby certify that
and being duly sworn acknowledged that the
Division President
Title or Authority
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a Notary Public of the County of
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Witness my hand and notarial seal, this day of
CANDIDA PERDOMO
Notary Public - North Carolina
Union County
My Commission Expires Nov 18, 2023
appeared personally before me this day
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exec y him.
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My commission expires
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