NCC222542_FRO Submitted_20220715

FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
EROSION & SEDIMENTATION CONTROL
No person may initiate any land -disturbing activity on one or more acres, M., 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 The Flats at Statesville
2.
3.
4.
5.
Location of land -disturbing activity: County
Iredell
City or Township Statesville
Highway/Street Solstice Dr Latitude35.819376 Longitude-80.880891
Approximate date land -disturbing activity will commence: Fall 2022
Purpose of development (residential, commercial, industrial, institutional, etc.): Residential
Total acreage disturbed or uncovered (including off -site borrow and waste areas): 4.51
6. Amount of fee enclosed: $ 875.00 . 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 X
8. Person to contact should erosion and sediment control issues arise during land -disturbing activity:
Name Josh Lipsky
E-mail Address [e-mail]
Telephone [phone] Cell #
Fax #
9. Landowner(s) of Record (attach accompanied page
to list additional owners):
Venture Properties I, LLC
Name
Telephone
Fax Number
PO Box 843
PO Box 843
Current Mailing Address
Current Street Address
Wilkesboro NC 28697
Wilkesboro NC
28697
City State Zip
City
State Zip
10. Deed Book No. 1059 Page No.635
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):
More Apartments, LLC
Name
401 E Fourth St, Suite 201
Current Mailing Address
jlipsky(cr_ rehabbuilders.com
E-mail Address
401 E Fourth St, Suite 201
Current Street Address
Winston Salem, NC 27101 Winston Salem, NC 27101
City State Zip City State Zip
Telephone [phone] Fax Number
Page 4 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
E-mail Address
Current Mailing Address
Current Street Address
City State Zip
City State Zip
Telephone
Fax Number
(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 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.
Josh Lipsky Managing Member
Type or print Title or Authority
�- j- z v
Signature Date
I, Ke n e-e— T Road a Notary Public of the County of F9 t-5 Q
—� _j
State of North Carolina, hereby certify that �� Or3� �--1 P�U 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 I St day of J tj VW, 20�
dz=�J_
Notary
Renee J. RQWZ My commission expires
NOTARY UC }
Forth co�+►y 14 4
iNont► Carolina
.my Commission Expines Jw4wy 30, 2p27 r
Page 2 of 2