NCC232751_FRO Submitted_20230913

FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
EROSION & SEDIMENTATION CONTROL
IREDELLNo person may initiate any land-disturbing activity on one or more acres, 1/2 acre or more inside a
COUNTY NC 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 Riverwalk Lot#37,395 Stewart Rock Rd
2. Location of land-disturbing activity: County Iredell City or Township N/A
Highway/Street 395 Stewart Rock Rd Latitude 35*04'08.85" Longitude 81*06'1.31"
3. Approximate date land-disturbing activity will commence: 9/15/2023
4. Purpose of development(residential, commercial, industrial, institutional, etc.): Residential
5. Total acreage disturbed or uncovered (including off-site borrow and waste areas): 1.5
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 Jeffery G.Norman E-mail Address [e-mail]
Telephone Cell# 803-526-8818 Fax#
9. Landowner(s)of Record (attach accompanied page to list additional owners):
Jeffery G.&Christina M.Norman 803-526-8818
Name Telephone Fax Number
4336 Jenkins Rd _
Current Mailing Address Current Street Address
Clover SC 29710 Clover SC 29710
City State Zip City State Zip
10. Deed Book No. 2928 Page No. 559 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):
Jeffery G. Norman [e-mail]
Name E-mail Address
4336 Jenkins Rd 4336 Jenkins Rd
Current Mailing Address Current Street Address
Clover SC 29710 Clover SC 29710
City State Zip City State Zip
Telephone [phone] Fax Number
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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:
Fidelity National Title Company,LLC [e-mail]
Name E-mail Address
223 S.West Street,Suite 900 223 S.West Street,Suite 900
Current Mailing Address Current Street Address
Raleigh NC 27603 Raleigh NC 27603
City State Zip City State Zip
Telephone [phone] Fax Number 913-489-5231
(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.
Jeffery G. Norman Property Owner
Type or print name Title or Authority
Date
I, j,..) Y �(�vl oa,6 , a Notary Public of the County of 0—CS
State of North Carolina, hereby certify that ,)e-F. U Nr appeared personally before me this day
and being duly sworn acknowledged that the above form Was executed by him.
Witness my hand and notarial seal,this I (0 day of 20
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Notary
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