NCC221804_FRO Submitted_20220518

Pitt County Received
" i � Planning Department
Development Services Building FEB 2 2 2022
1717 W. 5t" Street
Greenville, North Carolina 27834-1696�
Telephone: [phone] Planning oWctor
Fax: [phone]
Financial Responsibility / Ownership Form
Soil Erosion and Sedimentation Control Ordinance
No person may initiate any land -disturbing activity on one or more contiguous acres as
covered by the Act before this form and an acceptable erosion and sedimentation control plan
have been completed and approved by the Pitt County Planning Department. (Please type or
print and, if question is not applicable, place N/A in the blank.)
Part A.
1. Project Name Manning Farm
2. Location of land -disturbing activity: County Pitt
City or TownshipAyden , and Highway/Street Norris Store Road
3. Approximate date land -disturbing activity will be commenced: March 15th, 2022
4. Purpose of development (residential, commercial, industrial, etc.): Residential
5. Approximate acreage of land to be disturbed or uncovered: 21.72
6. Has an erosion and sedimentation control plan been filed? Yes ✓ No
7. Person to contact should sedimentation control issues arise during land -disturbing activity:
Name Bobby TrippTelephone 252-378-5284
8. Landowner(s) of Record (Use blank page to list additional owners):
Pleasant Plain, LLC _
Name(s) Name(s)
P.O. Box 128
Current mailing address Street address
Ayden NC 28513
City State Zip City State Zip
9. Recorded in Deed Book No. 1683 Page No. 490
Part B.
1. Person(s) or firm(s) who are financially responsible for this land -disturbing activity (Use
the blank page to list additional persons or firms):
Pleasant Plain, LLC
Name of person(s) or Firm(s) Name(s)
P.O. Box 128
Current mailing address Street Address
A den NC 28513
City State Zip City State Zip
252-378-5284
Telephone Telephone

2. (a) If the Financially Responsible Parry is a Corporation, give name and street address of
the Registered Agent.
Name(s)
Current mailing address
Street Address
City State Zip
City State Zip
Telephone
Telephone
(b) If the Financially Responsible Parry is a Partnership give the name and street address
of each General Partner (Use blank page to list additional partners):
Name(s)
Name(s)
Current mailing address
Current mailing address
City State Zip
City State Zip
Telephone
Telephone
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/her attorney- in fact or if not an individual by an officer, director, partner, or
registered agent with 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.
Bobby Tripp
� e
Owner/Developer
Titl or uthority
_-Z \l��-Z Z
Date
I, UE-So2441 7- a Notary Public of the County of I.EN��c� _- State
of North Carolina, hereby certify that 605B TI of
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 Ud+k day of f*SR� - . 20 2le
Notary
My commission expires