HomeMy WebLinkAboutNCC230335_FRO Submitted_20230207ova��
Gaston County
Gaston Natural Resources Department
1303 Cherryville Highway, Dallas, NC 28034 Telephone: 704-922-4181
Soil Erosion & Sedimentation Control
4
Financial Responsibility/Ownership
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 within the city limits of the incorporated municipalities of Gaston
County who have not adopted the Gaston County Soil Erosion & Sedimentation Control Ordinance,
before this form and an acceptable Soil Erosion & Sedimentation Control Plan have been completed and
approved by the Gaston County Natural Resources Department's staff.
PART A: (Please type or print and, if question is not applicable, place NIA in blank)
1. Project Name Carolina Riverside - Early EC - Village D2
2. Location of land -disturbing activity
city of Belmont Highway/Street Armstrong Ford Road
3. Approximate date land -disturbing activity will commence 1/1/2023
4. Purpose of development (residential, commercial, industrial, etc.)
Residential
5. Total acreage disturbed or uncovered (including off -site borrow and waste areas) 21.54
6. Amount of fee enclosed $ 6,600.00
7. Soil Erosion & Sedimentation Plan Filed? Yes X No
8. Landowner(s) of Record (Use blank page to list additional owners)
9
10.
Belmont #1 US321/74 Byeass LLC
Name
Selwyn Avenue Suite 500
Mailing Address
Charlotte NC 28209-1791
City State Zip
Telephone Number
Pulte Home Company, LLC
Name
11121 Carmel Commons Blvd, Suite
Mailing Address
Charlotte NC 2 22 -44
City State Zip
(704) 543-4922
Telephone Number
Indicate Deed Book and Page where deed(s) or instrument(s) are recorded
Deed Book PB 097 Page PG 068
Deed Book 5354 Page 0111
Tax Map No. 307993 Belmont #1 Block NIA
307989 (Puite)
Lot No. NIA
450
Page 1
PART B:
1. Person(s) or firm(s) who are financially responsible for this land -disturbing activity
Pulte Home Company,LLC
Name
11121 Carmel Commons Blvd. Suite 450
Mailing Address
Charlotte, INC 28220 _
City State Zip
704 543-4922
Telephone Number
Name
Mailing Address
City State Zip
Telephone Number
2. If the Financially Responsible Party is not a resident of North Carolina, give name and street
a caa v1 ❑ IVVI U I k. clluiII Id diAU1Il.
NIA
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
4. 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 corrected information should there be any change in the information provided
herein.
Jeremy Huntsman
Type or Print Name
r Signature
Director of Land Development
Title or Authority
11/2/2022
Date
1, a Notary Public of the County of IA*Z� State of North
Carolina, hereby certify that °' ,, vl+fvi-e 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 -° day of _Ev►VEW*&, 2 a22---
S
. • �.a qe�.1 G � �[ I ^ v2"j
Notary mmission Expires
THC7�MAS J. PATANEA, JR. File: Financial Responsibility -Ownership Form.mw
NOTARY PUBLIC
Lancaster County, South Carolina
My Commiesion Fxpiros January 9, 2027 Page 2