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Home My WebLink AboutNCC230188_FRO Submitted_202301231119123, 10:36 AM Rowan County Financial Responsibility/Ownership Form Sedimentation Pollution Control Ordinance No person may initiate any land -disturbing activity on one or more acres as covered by the ordinance before this form and an acceptable erosion and sedimentation control plan have been completed and approved by the Rowan County Environmental Management Department. Part A L Project Name* The Crescent - Muirfield Way 2. Location of land -disturbing activity (Highway/Street)* Lots 62-66 Muirfiield Way Latitude Longitude 35.703579-80.490578 IApproximate date land -disturbing activity will be commenced 01-30-23 4. Purpose of development (residential, commercial, industrial, etc.) Residential development 5. Approximate acreage of land to be disturbed or uncovered* 1.98ac 6. Person to contact should sediment control issues arise during land -disturbing activity* Matt Varney `this Information will be made available on the Rowan County Planning d Development websft Email Address mvarney@nesthomes.com Parcel ID Number 326H045,326H046 326H048,326H064, 326HO49 Cell Phone Number* 864-434-0764 /r 4 le httpsJAarww rowancountync.gov/FormCenterlPdrri?formlC=96&Preview=YES&Save=False&savedProgmsslD= 1/3 1119/23, 10.36 AM 7. Landowner of Record Rowan County r !��lf Holdings LLC Name Current MailingAddress PO Box 3965, Mooresville NC 28117 r. S. Recorded in Deed Book Number Landowner of Record N actin Current Mailing Address Page Number 1402 954 i r Part B 1. Person or Firm who are financially responsible for this land -disturbing activity Nest Homes LLC Name of Person(s) or Firm(s) f Current Mailing Address PO Box 3965, Mooresville WC 28117 i Person or Firm who are financially responsible for this land - disturbing activity Name of Person(s) or Firm(s) Current MallingAddress Phone Number Phone Number 704-500-1238 a. If the Financially Responsible Party is not a resident of North Carolina, give name and street address of a North Carolina Agent. Name of Agent Name of Agent t Current Mailing Address Current Mailing Address Phone Number Phone Number I." � httpsJlw Avrowancountync.govIFormCenterlPdnt?formlD=96&Previeur-YES&Savt--False&savedProgresslD= 213 1/19/23, 10:36AM Rowan County 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 the name and street address of the Registered Agent. Name of Registered Agent Todd Jason Farlow Current Mailing Address Current Street Address PO Box 3965, 236 Raceway Dr, St 7 Mooresville NC 28117 Telephone Number Telephone Number 980-500-1238 f 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). I agree to provide correctional information should there be any change in the information provided herein. Name Title or Authority Todd Jason Farlow General Counsel f Signature Date mmtddlyyyy c;ll3 . . . ... ............... ............................................ 1, ZzfGJGDX�-rallotaryPublicaftheCounhOf�r��ll state of North Carolina, hereby certify that appeared personally before me this day and being duly sworn acknowledged that the above form was executed by him/her. Witness my hand and seal of Notary, this LZ± day of pet/ Notary LAKETA DAVIS Iredell County Seal North Carolina My Commission Expires June 22.2027 Download a 00py of the Erosion and Sedimentation -Control Plan Checklist (E F}, My commission expires mm/dd yy . f,q9.e,' Z? zp ZF- https:ltwvwrn)wancountynagovlFormCenter/Pdn?fonnlD=96&Previe --YES&Save=False&savedProgressiD= 3/3