NCC221943_FRO Submitted_20220523

FINANCIAL RESPONSIBILITYIOWNERSHIP FORM
EROSION & SEDIMENTATION CONTROL
No person may initiate any land -disturbing activity on one or more acres, /z 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 Statesville Business Park -Flex Space
2. Location of land -disturbing activity: County Iredell City or Township Statesville
Highway/Street Business Park Dr. Latitude 35.749177 Longitude -80.783510
3. Approximate date land -disturbing activity will commence: 5/23/22
4. Purpose of development (residential, commercial, industrial, institutional, etc.): Commercial
5. Total acreage disturbed or uncovered (including off -site borrow and waste areas): 21.66-acres
6. Amount of fee enclosed: $ 3,850.00 . An application fee of $175.00 per acre (rounded up to the next acre) is
assessed without a ceiling amount (Example: a 8.10-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 $100.00 is assessed.
7. Has an erosion and sediment control plan been filed? Yes No Enclosed ve-
8. Person to contact should erosion and sediment control issues arise during land -disturbing activity:
Name Matthew Erich E-mail Address matt.erichi_i�_trustedcampaigns.com
Telephone [phone] Cell # 317435-9781 Fax #
9. Landowner(s) of Record (attach accompanied page to list additional owners):
SBP Realty LLC 317435-9781
Name Telephone Fax Number
1121 Old Concord Road Suite 1 1121 Old Concord Road Suite 1
Current Mailing Address Current Street Address
Salisbury, NC 28146-1473 Salisbury, NC 28146-1473
City State Zip City State Zip
10. Deed Book No. 2899 Page No. 2098 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):
SBP Realty, LLC [e-mail]
Name
1121 Old Concord Road Suite i
Current Mailing Address
Salisbury, INC 28146-1473
City State Zip
Telephone
E-mail Address
1121 Old Concord Road Suite l
Current Street Address
Salisbury, NC 28146-1473
City State Zip
Fax Number
Page 1 of 2

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
E-mail Address
Current Street Address
City State Zip City
Telephone
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 E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Telephone Fax Number
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 attomey-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.
Matthew Erich
Type rin e
Signature
Owner
Title or Authority
Date
Peyton Woody
I, , a Notary Public of the County of
Iredell
State of North Carolina, hereby certify that Matthew Erich 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 19th day of May 20 22
07
Notary
Seal
My commission expires
PEYTON WOODY
NOTARY PUBLIC
Iredell County
North Carolina
My CoMmission Expires
Page 2 of 2