NCC232121_FRO Submitted_20230714

FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
' f EROSION & SEDIMENTATION CONTROL
IR L D L L L No person may initiate any land-disturbing activity on one or more acres, '/: acre or more inside a
u c 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 Dollar General - Troutman
2. Location of land-disturbing activity: County Iredell City or Township Troutman
Highway/Street Charlotte Hwy Latitude 35.668814 Longitude-80.853614
3. Approximate date land-disturbing activity will commence: September 2023
4. Purpose of development(residential,commercial,industrial, institutional,etc.): Commercial
5. Total acreage disturbed or uncovered(including off-site borrow and waste areas): 1.42
6. Amount of fee enclosed:$ 350.00 . An application fee of$175.00 per acre(rounded up to the next acre)is
assessed without a ceiling amount (Example: a 8.10-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$100.00 is assessed.
7. Has an erosion and sediment control plan been filed? Yes No Enclosed X
8. Person to contact should erosion and sediment control issues arise during land-disturbing activity:
Name Joe Strickland E-mail Address [e-mail]
Telephone [phone] -Cell# 704-224-7364 Fax#
9. Landowner(s)of Record(attach accompanied page to list additional owners):
Teramore Development, LLC 229-516-4289
Name Telephone Fax Number
PO Box 6460 165 Big Star Drive
Current Mailing Address Current Street Address
Thomasville. GA 31758 Thomasville, GA 31758
City State Zip City State Zip
10. Deed Book No. 2999 Page No. 809 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):
Teramore Development, LLC [e-mail]
Name E-mail Address
214 Klumac Road Suite 101 214 Klumac Road Suite 101
Current Mailing Address Current Street Address
Salisbury NC 28144 Salisbury NC 28144
City State Zip City State Zip
Telephone [phone] Fax Number
Page 1 of 2

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 State Zip
Telephone Fax Number
(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 E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Telephone Fax Number
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.
Joe St( land Agent
Type o int name Title or Authority
g ture . Date
I, �/3!V`/-L 2' �L �a Notary Public of the County of R W.tn!
State of North Carolina, hereby certify that 5 U? S r,Q (r LAtiV appeared personally before me this day
and being duly sworn acknowledged that the above form was executed by hi .
27T1-j a uNT 2 3
Witness my hand and notarial seal,this day of 2
DANIEL R.ALMAZAN Notary
KOTARY PUBLIC UN �`
Rowan County My commission expires ,Z o 7.'7
North Carolina
My Commission Expires June 28,2027
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f,1
IREDELL
C O UNTY N
Grading Permit Application
No building permit shall be issued for a residential dwelling or a nonresidential principal structure until a grading permit has
been issued. No land shall be graded for the purpose of construction of a residential dwelling or nonresidential principal
structure, until a grading permit has been issued by the County. The County shall collect such fees for the issuance of grading
permits as are authorized by the fee schedule adopted by the Board of Commissioners.
1. Permit Number: Parcel Number: 4940934446.000
Parcel Address: 1060 Charlotte Hwy- Troutman, NC 28166
Total area of Parcel:1.19 acresTotal acreage being disturbed or uncovered: 1.42 acres
Lot Number: 3 Subdivision: Troutman Towne Center
2. Approximate date land-disturbing activity will commence: Sept. 2023
3. Purpose of development: ❑Residential ®Commercial
4. Applicant Contact Information:
Teramore Development, LLC-Joe Strickland 704-224-7364
Name Telephone Fax Number
214 Klumac Road Suite 101 Salisbury NC 28144
Current Mailing Address City State Zip
5. Landowner(s)of Record:
Teramore Development, LLC 229-516-4289
Name Telephone Fax Number
PO Box 6460 Thomasville, GA 31758
Current Mailing Address City State Zip
In Addition to obtaining the permit; the owner, building contractor, or other responsible party shall:
A. Control run-off as to not damage or adversely impact adjoining properties or natural watercourses by providing
sufficient erosion measures such as silt fence,drainage ditches, swales,etc.
B. Refrain from altering the general direction of natural drainage direction and avoid concentrated flows when
possible.
C. Schedule an inspection through Central Permitting, over the automated phone line, or online through Iredell
County Self Services, www.co.iredell.nc.us, when measures are in place prior to any building footing/foundation
inspection.
The applicant certifies that there are no deed restrictions, contractual agreements, or governmental regulations of
any kind that interfere with or prohibit the use of the property or the use for which this permit is requested.
Applicant further acknowledges that enforcement of deed restrictions, plat conditions, and other contractual
agreements will not be undertaken by Iredell County and is the sole responsibility of the affected parties.
Any land disturbing activity 1 acre and greater or 1/2 acre and greater inside of a watershed requires an erosion
control permit in addition to the grading permit. Failure to submit an erosion control plan prior to land disturbing
activity may result in penalties. Contact Iredell County Erosion Control Section at(704)832-2352 with any
questions.
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Applicant Signature: Date: �
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