NCC223418_FRO Submitted_20221010

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Town of Huntersville
lulSoil Erosion & Sedimentation Control Ordinance
NORTH T::;ROLTNA Financial Responsibility/Ownership Form
No person shall initiate any land -disturbing activity as defined in the Town of Huntersville Soil
Erosion and Sedimentation Control Ordinance prior to completing and filing this form with the Town
of Huntersville. The financially responsible party will be on record as the party to receive any
Notices of Violation or related documents related to non-compliance issues with the above
Ordinance. By filing this form, the parties are not relieved from any other permits that may be
required for the Project. If the financially responsible party is out of State, a North Carolina agent
must be assigned.
Please Type or Print
PART A
1. Project where land -disturbing activity is to be undertaken: Riverdale Phase Il
2. Address of land -disturbing activity: Tax ID #01312282
3. Approximate date land -disturbing activity will commence: July 01 2022
Month Day Year
4. Purpose of development (Residential, Commercial, Industrial, etc.): Residential
5. Approximate acreage of land to be disturbed or uncovered: +/- 23.13 acres
6. Total site acreage: +1- 33.39 Acres
7. Landowners of record (use blank pages to list additional owners as necessary) :
Owner #1 Name: Paul and Ruther Walters Family, LLC
Address: 102 Sherwood Drive
Huntersville, NC 28078
Telephone:
Email Address:
Owner #2 Name: N/A
Address:
Telephone:
Email Address:
Fax:
Fax:
8. Indicate Book and Page where the deed or instrument is filed (use blank pages to list
additional deeds or instruments as necessary)
Book 27097 Page 655 Book Page
Book Page Book Page

Financial Responsibility/Ownership Form - Continued
1. Person(s) or firm(s) financially responsible for this land -disturbing activity:
Persons or Firm: Eastwood Homes (Joe Polite)
Address: 2857 Westport Road
Charlotte, NC 28208
Telephone: [phone]
Email Address. [e-mail]
Fax:
2. North Carolina agent for the person or firm who is financially responsible:
Person or Firm:
Address:
Telephone:
Email Address:
Fax:
3. The above information is true and correct to the best of my knowledge and belief and was
provided by me while under oath. (This form must be signed by the financially responsible
person is an individual or by an officer, director, partner, attorney -in -fact, or other person
with authority to execute instruments for the financially responsible company or entity, if not
an individual)
Joe Polite
Printed Name
Vice President
Title
D to
a Notary
Public of the County of V (�V) 0(jIrVk State of NI C/ , hereby
certify that 1 � �) e e. Po I 1 1 r , personally appeared
before me on this day and under oath acknowledged that this form was executed by himlher.
Witness my hand and notarial seal, this
Notary Signature:
My Commission Expires:
day of DCL��M
Town of Huntersville
PO Box 664
105 Gilead Rd., Ste 300
Huntersville, NC 28070
E
tlyn Salley
ARY PUBLIC
enburg County
rth Carolina
xpires April, 27, 2025