NCC233779_FRO Submitted_20231221

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 !Chestnut at Laurelbrook Lots 650-651,656-669,789-822
2. PIN or 911 Address See attached
3. Purpose of development(residential, commercial, industrial, institutional,etc.)IResidential
4. Approximate soil disturbance date 'January 2024
5. Total acreage disturbed or uncovered(including off-site borrow and waste areas) 8. o 6 ci ac_r-e_s
6. Has an erosion and sedimentation control been filed? f Yes r- No R Attached
7. If you have an Erosion Control billing account,would you like this to be billed? r Yes V No
Account Number I
PEOPLE
8. Person to contact should erosion and sediment control issues arise during land-disturbing activity
Name !Cody Cosentino E-mail address Icoset0@drh000m
Telephone [phone] Cell# 1980-875-8669 Fax# N/A
9. Landowner(s) of Record(attach accompanied page to list additional owners)
Name'Chestnut at Laurelbrook LLC Telephone [phone] Fax# i/A
Current Mailing Address 17224 Jameson Way
City !Stanley State INC Zip 128164
Current Street Address I7224Jameson Way
City 'Stanley State INC Zip 128164
10. Deed Book No. I Page No.
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 address Icosto@ortouiom
Current Mailing Address 18025 Arrowridge Blvd
City (Charlotte State INC Zip 128273

Current Street Address 8025 Arrowridge Blvd
City 'Charlotte State INC Zip 128273
Telephone J980-875-8669 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 I Zip
Current Street Address I
City State I Zip I
Telephone I Fax# I
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 ICT Corporation System E-mail address ([e-mail]
Current Mailing Address 1160 Mine Lake Court Suite 200
City !Raleigh State iJC Zip 127615
Current Street Address 1160 Mine Lake Court Suite 200
City 'Raleigh State INC Zip 127615
Telephone [phone] Fax# I
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.
CCiNt•n}-in0 DIJi6on S-I-errAA),x4er eor+np1( C(. Spec-iatic-I- it
Ty *I or Print Name Title of Authority
11j84
Sign re Date
I, 'Ciu ht/A/l 1r l Yl /-4 l ?S , a Notary Public of the County of C a S-I V\ State of North
Carolina,hereby certify that Cc d Lf L s em f i V1 D appeared personally before me this day and being duly
sworn acknowledge that the above form was executed by him.
Witness my hand and notary seal,this a I day of Kf u V2.Wl bey ,20 a 3
6-RculLa Ynaudait-
RACHEL MARTIN HAYES Notary
Notary Public,North Carolina
Gaston County My Commission expires Ata d a co 5
My Commission Expires
Ma 27,2025 Print Form