NCC232475_FRO Submitted_20230816

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 or print, and if question is not applicable,please N/A in the blank)
PART A
1. Job Name (Falls at Hickory Lots 1-25,44,74-94
2. PIN or 911 Address 371412778284
3. Purpose of development(residential, commercial, industrial, institutional,etc.)IResidential
4. Approximate soil disturbance date (September 2023
5. Total acreage disturbed or uncovered(including off-site borrow and waste areas) I ( ,
6. Has an erosion and sedimentation control been filed? r Yes r No 17 Attached
7. If you have an Erosion Control billing account, would you like this to be billed? r. Yes No
Account Number I
PEOPLE
8. Person to contact should erosion and sediment control issues arise during land-disturbing activity
Name ICodyCosentino j E-mail address [e-mail]
Telephone I980-875-8669 Cell# 1980-875-8669 j Fax# I
9. Landowner(s) of Record(attach accompanied page to list additional owners)
Name ICK Contractors and Development, LLC Telephone IN/A Fax#
Current Mailing Address Fiblooding Place
City (Kings Mtn. State (North Carolina Zip 128086 -
Current Street Address 124 Wooding Place
City (Kings Mtn. State (North Carolina Zip 128086
10. Deed Book No. 193787 Page No. 0373-0377
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 ID.R.Horton,Inc. E-mail [e-mail]
Current Mailing Address I8025 Arrowridge Blvd.
City (Charlotte State (North Carolina Zip 128273

Current Street Address 18025 Arrowridge Blvd.,
City I8025 Arrowridge Blvd., State I8025 Arrowridge Blvd. Zip 128273
Telephone I980-875-8669 ] Fax# IN'A
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 I E-mail address I
Current Mailing Address I
City I State Zip
Current Street Address I
City I State I Zip I
Telephone Fax #
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 CT Coporation System E-mail address [e-mail]
Current Mailing Address1160ine Lake Ct.Suite 200 j
M
City Raleigh State (North Carolina Zip 127615
Current Street Address I60 Mine Lake Ct.Suite 200
City Raleigh State IN0hCarohu1a Zip 127615
Telephone [phone] Fax# N/A
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 be any change in the information provided herein.
L.CciL4 CsenA--i (\.d N P o ES I`'l atn Aq e r
T . Print Nam Title of Authority
Signal e Date
I, 1 CAM , a Notary Public of the County of AteGICIe41iisArl, State of North
Carolina,hereby certify that Ct e•14 0t0 appeared personally fore me this day and being duly
sworn acknowledge that the above(form was executed by him.
Witness my hand and notary seal, this erA day of Atil V ,201-3
Set
LOGAN F. CREECH Notary Public, North Carolina /� �027
Mecklenburg County My ommission expires
My Commission Expires
March 03,2027 Print Form