NCC232286_FRO Submitted_20230731

°ovNTA Gaston County
a' 9Gaston Natural Resources Department
i lilyIr 1303 Cherryville Highway, Dallas, NC 28034 Telephone: [phone]
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�,•tn ��, Stormwater
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Financial Responsibility/Ownership
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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 Stormwater Ordinance, before this form and an
acceptable Stormwater 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 Winterlake-Phase 2(Lots 1-7)
2. Location of land-disturbing activity
City Gastonia Highway/Street Elam St.&Judson Dr.
3. Approximate date land-disturbing activity will commence 06/2023
4. Purpose of development(residential, commercial, industrial, etc.) Residential
5. Total acreage disturbed or uncovered (including off-site borrow and waste areas) 2.34
6. Amount of fee enclosed $900
7. Soil Erosion &Sedimentation Plan Filed? Yes X No
8. Landowner(s) of Record (Use blank page to list additional owners)
J.P.Development Group,LLC
Name Name
4301 Fairview Oaks Dr.
Mailing Address Mailing Address
Charlotte NC 28211
City State Zip City State Zip
704-367-9100
Telephone Number Telephone Number
9. Indicate Deed Book and Page where deed(s) or instrument(s) are recorded
Deed Book Page
Deed Book Page
10. Tax Map No. Block Lot No.
Page 1

PART B:
1. Person(s) or firm(s)who are financially responsible for this property.
Eastwood Construction, Ta rydr% L.L-c: Marc Battiste
Name Contact Name for Inspection Reports
2857 Westport Rd. [e-mail]
Mailing Address Email Address
Charlotte NC 28208 704-399-4663
City State Zip Telephone Number
704-507-7033
Telephone Number Fax Number
2. If the Financially Responsible Party is not a resident of North Carolina, give name and street
address of a North Carolina agent.
Name
Mailing Address Street Address
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.
Marc Battiste VP of Construction
Type or Print Name Title or Authority
G . zz- Z07_3
Signs u //11 Date
I, 14. 1a01'1,� , a Notary Public of the County of 1-44 Col n , State of North
Carolina, her y certify that -le. appeared personally before me this day
and being duly sworn acknowle ged that the above form was executed by him.
Witn y hand nd notar.al seal,this o'? 4V',of,, _, , 2003 .
• --2`�
N .S �TA '(vly Commission Expires
' s File:Financial Responsibility-Ownership Form.mw
rZ C/B L1 ;�V Page 2
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