NCC222472_FRO Submitted (2)_20220726

4394
WELLS FARGO BANK N.A.
NEWSTYLE COMMUNITIES, INC.
sV 2125 SOUTHEN❑ DR., UNIT 453 11-24 1210
CHARLOTTE, NC 28203
[phone]
01 /27/2022
PAY TO THE Gaston County Natural Resources Departme 4,200.00
f ORDER OF
*************FOUR THOUSAND TWO HUNDRED AND 00/100 DOLLARS************* DOLLARS
i
Gaston County Natural Resources Departme
1303 Dallas-Cherryville
n'
Dallas, NC 28034 `� _- � ,
}
MEMO :r 11iel,sia
.r
_-�—

NEWSTYLE COMMUNITIES, INC.
004394 01 /27/22
NewStyle Communities, Inc.
VENDOR: 170016 Gaston County Natural Resources Departme
INVOICE DATE DESCRIPTION GROSS AMT
GNRD FRO 01/27/22 GNRD FRO
4,200.00
4,200.00
NEWSTYLE COMMUNITIES, INC. 004394 01/27/22
NewStyle Communities, Inc.
VENDOR: 170016 Gaston County Natural Resources Departme
INVOICE DATE DESCRIPTION GROSS AMT
GNRD FRO 01/27/22 GNRD FRO
4,200.00
4,200.00
vaopucr SSlrtp.! USE Willi 91MIENVLL opt Doluxo Corporation 1-800-328.030s or www.doluxo.00nVshop
DISCOUNT
0
4394
NET PAID
4,200.00
00 4,200.00
4394
DISCOUNT
11
1►1:0r2G1l9
4,200.00
00 4,200.00
w
6927662300

COO.-
Gaston County
�,Gaston Natural Resources Department
f303 Cherryville Highway, Dallas, NC 28034 Telephone: [phone]
Stormwater
Financial Responsibility/Ownership
o�p�
No person may initiate any land -disturbing activity on one (1) or more acres of property in all portions of
Gaston County, except for that property withrn the city limits of the incorporated municipalities of Gaston
County who have not adopted the Gaston County Stormwater Ordinance, before this form and an
acceptable Stormwater Plan have been completed and approved by the Gaston County Natural
Resources Department's staff.
(Please type or print and, if question is not applicable, place NIA in blank)
PART ❑-
2.
I
no
5
6
7
8
fire]
Project Name The Courtyards of Gastonia
Location of land -disturbing activity
City Gastonia Highway/Street NC-2791South New Hope Rd
Approximate date land -disturbing activity will commence .tune 1 , 2022
Purpose of development (residential, commercial, industrial, etc.) Residential
Total acreage disturbed or uncovered (Including off -site borrow and waste areas) 11.79
Amount of fee enclosed $ 4,200 (12 x $350)
Soil Erosion & Sedimentation Plan Filed? Yes X No
Landowner(s) of Record (Use blank page to list additional owners)
Catherine B Wilson Rev Trust
Name
CIO Parks H Wilson JR PO Box 901
Mailing Address
Belmont NC 28012
City State Zip
Telephone Number
Martha G Wilson Rev Trust
Name
„501 Ves Rd Apt B116
Mailing Address
Lynchburg VA 24503
City State Zip
Telephone Number
Indicate Deed Book and Page where deed(s) or instrument(s) are recorded
Deed Book 2020E Page 0171
Deed Book 5253 Page 0584
0872 0282
Tax Map No. 148738, 148734, Block Lot No.
148735,148736
Page 1

John D & Anne C Wilson
Name
700 Durant St Apt 201
Mailing Address
Chapel Hill NC 27517
City State Zip
Telephone Number

PART B:
1. Person(s) or firms) who are financially responsible for this property.
Brock L. Fankhauser with NewStvl
Name
2125 Southend Drive. Suite 453
Mailing Address
Charlotte NC 28203
City State Zip
704-837-8301
Telephone Number
Comm
pities, Inc.
Contact Name for Inspection Reports
Email Address
Telephone Number
Fax Number
2. If the Financially Responsible Party is not a resident of North Carolina, give name and street
address of a North Carolina agent.
Name
Mailing Address Street Address
City State Zip Telephone Number
3. 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 Part is a Corporation give name and street address of the Registered Agent.
Name
Mailing Address Street Address
City State Zip Telephone 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 authority to execute instruments for the financially responsible person).
agree to provide corrected information should there be any change in the information provided
herein.
13�aav�kr G�r�Sid�w�
tint N me Title or Authority
Si at Date
I, T ',VCkC(•t,J— a Notary Public of the County of MQG1 -i tate of North
Carolina, hereby certify that rpCyyE� appeared personallye re bme this day
and being duly sworn acknowledged that t e above fort s executed by him.
I 1,,,,,Witness my hand and notarial seal, this 3& day of MLA1�, 2D�Z .
Q �� IN }'r SEAL My o �issi n Expires
�ao R }- e File: Financial Responsibility -Ownership Form.mw
C]
~ �r pUB�-1G Page 2
URG
^l/l 111 1, i ll l isl"1,