NCC222394_FRO Submitted_20220630

No person may initiate any land -disturbing activity on one or more acres, 'h acre or more inside a watershed, as covered by the
Sedimentation Pollution Control Act and the Iredell County Land Development Code, before this form and an acceptable erosion
and sedimentation control plan have been submitted and approved by the Iredell County Development Services, Planning Division -
Erosion Control Section. (Please type or print.)
Part A.
1. Project Name Shepherd's Landing Subdivision
2. Location of land -disturbing activity: County Iredell City or Township Mooresville
Highway/Street Charlotte Hwy/US 21 Latitude 35.6324 Longitude -80.8246
3. Approximate date land -disturbing activity will commence: March 15, 2020
4. Purpose of development (residential, commercial, industrial, institutional, etc.): Residential
5. Total acreage disturbed or uncovered (including off -site borrow and waste areas): 57.00 ac.
6. Amount of fee enclosed: $ 9,975.00 . 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 .5 acre but < 1.0 acre
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 Doug Testa E-mail Address [e-mail]
Telephone [phone] Cell # Fax # [phone]
9. Landowner(s) of Record (attach accompanied page to list additional owners):
Shepherds Landing, LLC 704-892-2995 704-892-2996
Name Telephone Fax Number
19905 West Catawba Ave. 19905 West Catawba Ave.
Current Mailing Address Current Street Address
Cornelius NC 28031 Cornelius NC 28031
City State Zip City State Zip
10. Deed Book No. 2479 Page No. 2423 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):
Shepherds Landing, LLC [e-mail]
Name E-mail Address
19905 West Catawba Ave. 19905 West Catawba Ave.
Current Mailing Address Current Street Address
Cornelius NC 28031 Cornelius NC 28031
City State Zip City State Zip
Telephone [phone] Fax Number 704-892-2996
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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 i the information provided herein.
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Type or pr' t name Title or Authority
§gnatufd Date
Notary Public of the County of
State of North Carolina, hereby certify that 12L, UTAIW �) ° 1CdIL4 appeared personally before me this day
and being duly sworn acknowledged that t-above for was executed by him.
Witness my hand and notarial seal, this day of -' f �tP 20
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