NCC232170_FRO Submitted_20230721

PLAN REVIEW/FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
CATAWBA COUNTY CODE OF ORDINANCES, CHAPTER 16 ARTICLE V
SOIL EROSION AND SEDIMENTATION CONTROL
No person may initiate any land-disturbing activity on one or more acres as covered by the Ordinance before this form
and an acceptable erosion and sedimentation control plan have been completed and approved by the Catawba County
Utilities and Engineering Department. (Please type in.prim, and if'question is not applicable,please NM in the blank)
PART A
1. Job Name IBEAR PARK
2. PIN or 911 Address 1371412970462,371412960.319,371412866394
3. Purpose of development(residential, commercial, industrial, institutional,etc.)IRESIDENTIAL
4. Approximate soil disturbance date Is'1t22
5. Total acreage disturbed or uncovered (including off-site borrow and waste areas) 123.99
6. Has an erosion and sedimentation control been filed? r yes E. No IR Attached
7. If you have an Erosion Control billing account, would you like this to be billed? IT Yes g No
Account Number INA
PEOPLE
8. Person to contact should erosion and sediment control issues arise during land-disturbing activity
Name 'DAVID EARNHARDT E-mail address [e-mail]
Telephone I Cell # 1704-458-7050 Fax # I
9. Landowner(s) of Record (attach accompanied page to list additional owners)
Name'Gary Steven Green& The [state of Elei Telephone F -3:2-2 183 Fax# I
Current Mailing Address F362116th ST NE
City 'Hickory State INC Zip 128601
Current Street Address 13621 16 ST NE
City (Hickory • State INC Zip 128601
10. Deed Book No. I Page No.
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 attached sheet):
Name (BELL CREEK DEVELOPMENT E-mail address [e-mail]1
Current Mailing Address 2401 HOB R: COURT
City 'CHARLOTTE Yr State NC Zip I

Current Street Address (SAME
City I State Zip I
Telephone I704-458-7050 Fax
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 INA E-mail address
Current Mailing Address i
City I State i Zip I.
Current Street Address I
City I State I Zip
Telephone I Fax # I
2. (b) If the financially responsible party is a Partnership or other person engaging in business under 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 I E-mail address I
Current Mailing Address I
City I State I Zip
Current Street Address i
City I State I Zip
Telephone I Fax # I
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
ovide corrected information should there be any change in the information provided her
ype or ' + ► fir - Title of Muth tE
- Z 7- Z
Signature - Date
I, 111! 0114 4 4,1176.3 __ _ a Notary Puhli•of the County of j� .erv��r9t State of North
Carolina,hereby certify that '"�p,V i' K. EQ✓el h4 r, appeared personally before me this day and being duly
sworn acknowledge that the above form was executed by him.
Witness my hand and notary seal,this 2 7+11 day of J In`i.L ,202,2.
Seal -7-X.:1-4i-a 0 4.. 6�9t1,
MONA ALABBAS Notary Notary Public, North Carolina My Commission expires 1022
Mecklenburg County
My Commission Expires F-rint.f=QYm
August 03,2023