Loading...
HomeMy WebLinkAboutNCC231349_FRO Submitted_20230508 0,24. Gaston County Gaston Natural Resources Department 1303 Cherryville Highway, Dallas, NC 28034 Telephone: 704 922 4181 es �•KnA`�9 Soil Erosion & Sedimentation Control 0 .....�y Financial Responsibility/Ownership Afp 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. (Please type or print and, if question is not applicable, place N/A in blank) PART A: 1. Project Name Howe's Landing Residential Off-site Improvments Phase 1 2. Location of land-disturbing activity City Gastonia Highway/Street Howe Dairy Road 3. Approximate date land-disturbing activity will commence January 2023 4. Purpose of development (residential, commercial, industrial, etc.) Residential 5. Total acreage disturbed or uncovered (including off-site borrow and waste areas) 1.9 ac 6. Amount of fee enclosed $600 7. Soil Erosion & Sedimentation Plan Filed? Yes X No 8. Landowner(s) of Record (Use blank page to list additional owners) Name Name Mailing Address *SEE ATTACHED SHEET FOR PROPERTY INFORMATION* City State Zip City State Zip Telephone Number Telephone Number 9. Indicate Deed Book and Page where deed(s)or instrument(s) are recorded Deed Book Pane Deed Book *SEE ATTACHED SHEET FOR PROPERTY INFORMATION* 10. Tax Map No Lot No. Page PART B: 1. Person(s)or firm(s)who are financially responsible for this land-disturbing activity TriGate Suncrest Howe Landing LLC Name Name 2701 E Camelback Road, Suite 180 Mailing Address Mailing Address Phoenix AZ 85016 __ _ City State Zip City State Zip 704.995.3290 Telephone Number Telephone Number 2. If the Financially Responsible Party is not a resident of North Carolina, give name and street address of a North Carolina agent. CT Corp Name 150 Fayetteville Street Mailing Address Street Address Raleigh _ _ _ NC 27601 919-821-7139 City State Zip Telephone Number 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. SFAN Coo Ma.N,s.43eF.% Type or Print Name Title or Authority /Zv't..Z Signature Date gr;VA I, C1 C 1 a Notary Public of the County of NAfic poi , State of North Gerotirta, ereby certify that 55C� eoo4e( appeared persoNally before me this day and being duly sworn acknowledged that theabove form as executed by him. -ss my hand and notarial seal, this Idtday of a 4A9 , 20e&2 . •.er , Mgt/ '7 ,O9 Not"' „�,,., GAGE KCS My Commission Expires Notary Public-Arizona File:Financial Responsibility-Ownership Form.mw W4}1 Maricopa County Commission#574473 My Comm.Expires Nov 7,2023 Page 2 1. TriGate-Suncrest Howe Landing LLC 2701 East Camelback Road, Suite 180, Phoenix, AZ 85016 DB: 5340 PG: 1616 Tax Parcel: 141615 PIN: 3544932510 2. TriGate-Suncrest Howe Landing LLC 2701 East Camelback Road, Suite 180, Phoenix, AZ 85016 DB: 5340 PG: 1406 Tax Parcel: 307554 PIN: 3544932510 3. TriGate-Suncrest Howe Landing LLC 2701 East Camelback Road, Suite 180, Phoenix, AZ 85016 DB: 5340 PG: 1375 Tax Parcel: 220216 PIN: 3544932510 4. TriGate-Suncrest Howe Landing LLC 2701 East Camelback Road, Suite 180, Phoenix, AZ 85016 DB: 5340 PG: 1526 Tax Parcel: 305081 PIN: 3544932510