NCC230546_FRO Submitted_20230302

FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
EROSION & SEDIMENTATION CONTROL
No person may initiate any land -disturbing activity on one or more acres, % 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 Morrison Plantation Storage
2 Location of land -disturbing activity: County Iredell City or Township Mooresville
Highway/Street Northside Drive Latitude 35.583669 deg. Longitude-80.881305 deg.
3. Approximate date land -disturbing activity will commence: 1 /30/2023
4. Purpose of development (residential, commercial, industrial, institutional, etc.): Commercial
5. Total acreage disturbed or uncovered (including off -site borrow and waste areas): 3.40 AC
6. Amount of fee enclosed: $ 700.00 . An application fee of $175.00 per acre (rounded up to the next acre) is
assessed without a ceiling amount (Example: a 9-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 $135.00 is assessed.
7. Has an erosion and sediment control plan been filed? Yes No Enclosed_
8. Person to contact should erosion and sediment control issues arise during land -disturbing activity:
Name Alkesh Patel E-mail Address [e-mail]
Telephone Cell # 704 - 737 - 5515 Fax #
9. Landowner(s) of Record (attach accompanied page to list additional owners):
Sunrise Storage, LLC 704-846-1099
Name Telephone Fax Number
1348 Matthews Township Pkwy. Suite 200
Current Mailing Address Current Street Address
Matthews NC 28105
City State Zip City State Zip
10. Deed Book No. 2889 Page No. 2252-2254 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):
Sunrise Storage, LLC
Name E-mail Address
1348 Matthews Township Pkwy. Suite 200
Current Mailing Address Current Street Address
Matthews NC 28105
City State Zip City State Zip
Telephone [phone] Fax Number
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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
Telephone
Fax Number
State Zip
(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
Current Mailing Address
E-mail Address
Current Street Address
City State Zip City
Telephone. Fax Number -
State Zip
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.
Alkesh Patel
Type or rint name
bighature
Owner
Title or Authority
1212-0 1 22,
Date
a Notary Public of the County of
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.
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