NCC233780_FRO Submitted_20231221

FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
EROSION & SEDIMENTATION CONTROL
1 R E D E L L No person may initiate any land-disturbing activity on one or more acres, % acre or more inside a
N c 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 Overhill Drive
2. Location of land-disturbing activity County Iredell City or Township Mooresville
Highway/Street Oates Road Latitude35 35' 56.5 N Longitude8° 51' 27.83 W
3. Approximate date land-disturbing activity will commence: 12/15/2023
4. Purpose of development(residential, commercial, industrial, institutional, etc.): Industrial
5. Total acreage disturbed or uncovered (including off-site borrow and waste areas): y1 3
6. Amount of fee enclosed: $ 1450.00 . 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 X No Enclosed
8. Person to contact should erosion and sediment control issues arise during land-disturbing activity:
Name Bill Boat E-mail Address [e-mail]
Telephone [phone] Cell# 602 920-9801 Fax#
9. Landowner(s)of Record (attach accompanied page to list additional owners):
Boat Land Development 602 920-9801
Name Telephone Fax Number
125 Infield Court 125 Infield Court
Current Mailing Address Current Street Address
MnnresvillP NC 28117 Mooresville, NC 28117
City State Zip City State Zip
10. Deed Book No. 2872 Page No 139 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):
Boat Land Development [e-mail]
Name E-mail Address
125 Infield Court 125 Infield Court
Current Mailing Address Current Street Address
Mooresville, NC 28117 Mooresville, NC 28117
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:
Name E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Telephone 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.
Cliff Homesley [e-mail]
Name of Registered Agent E-mail Address
330 S Main Street 330 S Main Street
Current Mailing Address Current Street Address
Mooresville, NC 28115 Mooresville, NC 28115
City State Zip City State Zip
Telephone [phone] Fax Number 704 664-0267
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.
' I LINM C21�1 6F JE PlyIZ" 1 AA 1Z_
Type or print n e Title or Authority
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Signature Date
, � �7
I, -(r))/rrj / u(e , a Notary Public of the County of ireo eL/
State of North Carolina, hereby certify that hi' II /L%,, 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,�1U - 'day of r mI i ,2 3
SealTAMMY S WOOD Notary
/
Notary Public My commission expires
Iredell Co., North Carolina
My Commission Expires June 14,2028
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