NCC231255_FRO Submitted_20230428

cow Pitt County
mot. Planning Department
Development Services Building
\� Ac Greenville,
W. 5 Street
, North Carolina 27834-1696 James F.Rhodes,AICP
Telephone: [phone] Director
Fax: [phone]
Financial Responsibility/Ownership Form
Soil Erosion and Sedimentation Control Ordinance
No person may initiate any land-disturbing activity on one or more contiguous acres as
covered by the Act before this form and an acceptable erosion and sedimentation control plan
have been completed and approved by the Pitt County Planning Department. (Please type or
print and, if question is not applicable,place N/A in the blank.)
Part A.
1. Project Name Windfield Subdivision- Preliminary Clear&Grub
2. Location of land-disturbing activity: County Pitt
City or Township Grimesland , and Highway/Street Poker House Rd. (SR 1589)
3. Approximate date land-disturbing activity will be commenced:Spring/Summer 2023
4. Purpose of development(residential, commercial, industrial, etc.): Residential
5. Approximate acreage of land to be disturbed or uncovered:29.7
6. Has an erosion and sedimentation control plan been filed? Yes V No (herewith)
7. Person to contact should sedimentation control issues arise during land-disturbing activity:
Name Hunter Stone Telephone [phone]
8. Landowner(s) of Record (Use blank page to list additional owners):
H &S Land, LLC Same
Name(s) Name(s)
3204 Nash St. N., Ste. C Same
Current mailing address Street address
Wilson NC 27896 Same
City State Zip City State Zip
9. Recorded in Deed Book No. 4286 Page No. 389
Part B.
1. Person(s) or firm(s) who are financially responsible for this land-disturbing activity (Use
the blank page to list additional persons or firms):
H & S Land, LLC Same
Name of person(s)or Firm(s) Name(s)
3204 Nash St. N., Ste. C Same
Current mailing address Street Address
Wilson NC 27896 Same
City State Zip City State Zip
252-230-9068 Same
Telephone Telephone

2. (a) If the Financially Responsible Party is a Corporation, give name and street address of
the Registered Agent.
N/A
Name(s)
Current mailing address Street Address
City State Zip City State Zip
Telephone Telephone
(b) If the Financially Responsible Party is a Partnership give the name and street address
of each General Partner(Use blank page to list additional partners):
N/A
Name(s) Name(s)
Current mailing address Current mailing address
City State Zip City State Zip
Telephone Telephone
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/her 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.
Hunter Stone eli lef5Z / t //7'V 4' L
Tiyl. MIIPC Title o Authori
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I, go,„/„,h, a,,,.,,,, a Notary Public of the C unty of MLA'or/ State
of North Carolina, hereby certify that uP ,c��F
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 /7 day of /I ,ez . 2073.
Steven Lee Oliverio Notary
NOTARY PUBLIC My commission expires/1-67,-7,623
Wilson County,INC
My Commission Expires// /