NCC233424_FRO Submitted_20231212

FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
SEDIMENTATION POLLUTION CONTROL ACT
No person may initiate any land-disturbing activity on one or more acres as covered by the Act before this
form and an acceptable erosion and sedimentation control plan have been completed and approved by the
Land Quality Section, N.C. Department of Environment and Natural Resources. (Please type or print and, if
the question is not applicable or the e-mail and/or fax information unavailable, place N/A in the blank.)
Part A.
1. Project Name Cameron Woods Phase 7A & 7B
2. Location of land-disturbing activity: County Brunswick City or Township Ocean Isle Beach
Highway/Street Jenrette Rd Latitude 33.921806 Longitude-78.467567
3. Approximate date land-disturbing activity will commence: Upon permit receipt
4. Purpose of development(residential, commercial, industrial, institutional, etc.): Residential
5. Total acreage disturbed or uncovered (including off-site borrow and waste areas): 11 ac
6. Amount of fee enclosed: $ 1,100 . The application fee of $65.00 per acre (rounded
up to the next acre) is assessed without a ceiling amount (Example: a 9-acre application fee is $585).
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 Jason Byham E-mail Address [e-mail]
Telephone[phone] Cell # [phone] Fax#
9. Landowner(s)of Record (attach accompanied page to list additional owners):
Lennar Carolinas, LLC [phone]
Name Telephone Fax Number
1941 Savage Rd, Suite 100-C 1941 Savage Rd, Suite 100-C
Current Mailing Address Current Street Address
Charleston SC 29407 Charleston SC 29407
City State Zip City State Zip
10. Deed Book No.04717 Page No. 1135 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):
Lennar Carolinas, LLC [e-mail]
Name E-mail Address
1941 Savage Rd, Suite 100-C 1941 Savage Rd, Suite 100-C
Current Mailing Address Current Street Address
Charleston SC 29407 Charleston SC 29407
City State Zip City State Zip
Telephone[phone] Fax Number

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:
Graeme T. Black [e-mail]
Name E-mail Address
1 Sun Court same
Current Mailing Address Current Street Address
Carolina Shores NC 28467 Same
City State Zip City State Zip
Telephone [phone] 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:
Jason Byham [e-mail]
Name of Registered Agent E-mail Address
1941 Savage Rd, Suite 100-C 1941 Savage Rd, Suite 100-C
Current Mailing Address Current Street Address
Charleston SC 29407 Charleston SC 29407
City State Zip City State Zip
Telephone[phone] 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 be any change in the information provided herein.
Jason Byham Division President
or p ' t name Title or Authority
ri f3l i
Satre Data
I, , a Notary Public of the County of
Jason Byham
State of North-Carolina, hereby certify that 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 1 ay of Prl'f Oa- , 20 2.9
Notary
Seal
2)
My commission expires ,
DEBRA JONES
NotaY Public,State of South Carona
My Commission Expires 8P27/2023