NCC222373_FRO Submitted_20220630

Part A.
FINANCIAL RESPONSIBILITYIOWNERSHIP FORM
EROSION & SEDIMENTATION CONTROL
No person may initiate any land -disturbing activity on one or more acres, 'f 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 TTMEIVED
(Please type or print.)
1. Project Name
Swann Hills MAY 18 2022
2. Location of land -disturbing activity: County. Iredel) City or Township Cool Springs
Highway/Street Hwy 64 & Swann Rd latitude 35.825395 Longitude 80.757088
3. Approximate date land -disturbing activity will commence:
03-01-22
4. Purpose of development (residential, commercial, industrial, institutional, etc.): Residential
5. Total acreage disturbed or uncovered (including off -site borrow and waste areas); 3.449
6. Amount of fee enclosed: $ 200.00 . 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 X
8. Person to contact should erosion and sediment control issues arise during land -disturbing activity:
Name Mason Slagle E-mail Address [e-mail]
Telephone Cell # 704-400-6472
9. Landowner(s) of Record (attach accompanied page to list additional owners):
Christian & Leslie Lee
Name
190 Swann Rd
Current Mailing Address
Statesville NC 2865
City
State Zip
Telephone
Current Street Address
Fax #
Fax Number
City State Zip
10. Deed Book No. 2843 Page No. 1866 Provide a copy of the most current deed.
Part S.
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);
Redhead Land & Development, L.L-C
Name
301 Watkins Farm Rd
Current Mailing Address
Woodleaf NC 27054
City State Zip
Telephone [phone]
[e-mail]
E-mail Address
Current Street Address
City State Zip
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
E-mail Address
Current Mailing 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, 2tt2ch
a copy of the Cert flcate of Assumed Name. If the Financially Responsible Party is a Corporation, give name and street
address of the Registered Agent:
Jason Slagle icicustomconstructionOgmail.com
Name of Registered Agent E-mail Address
310 Watkins Farm Rd
Current Mailing Address Current Street Address
Woodleaf NC 27054
City State Zip City State Zip
Telephone [phone] 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_
o N lloar /tt5 r G
Type o Tint name TitlEl or Auk only
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Signat re Date
A-) I b Q VYUS,, a Notary Public of the County of
State of North Carolina, hereby certify that _Zam ?1.) 1 Is LU' lr_ _ e appeared personally before me this day
and being duly swum acknowledged that the above form was executed by'h m.
Witness my hand and notarial seal, this I day of 20
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Seal 007A Y
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