NCC240223_FRO Submitted_20240126

!'� ' Gaston County
:Jr Gaston Natural Resources Department
al !j) 1303 Cherryville Highway, Dallas, NC 28034 Telephone: [phone]
Iiaaea� Soil Erosion & Sedimentation Control
P $a\1
�es I� Financial Responsibility/Ownership
a
No person may initiate any land-disturbing activity on one (1) or more acres of property in all portions of
Gaston County, except for that property within the city limits of the incorporated municipalities of Gaston
County who have not adopted the Gaston County Soil Erosion & Sedimentation Control Ordinance,
before this form and an acceptable Soil Erosion & Sedimentation Control Plan have been completed and
approved by the Gaston County Natural Resources Department's staff.
(Please type or print and, if question is not applicable, place N/A in blank)
PART A:
1. Project Name Villages at Cramerton Mills Phase C
2. Location of land-disturbing activity
City Cramerton Highway/Street Cramerton Mills Parkway
3. Approximate date land-disturbing activity will commence June 19, 2020
4. Purpose of development (residential, commercial, industrial, etc.) Residential
5. Total acreage disturbed or uncovered (including off-site borrow and waste areas acres
6. Amount of fee enclosed $
2,800 %,15
7. Soil Erosion &Sedimentation Plan Filed? Yes V No
8. Landowner(s)of Record (Use blank page to list additional owners)
VCM Bowman, LLC
Name Name
13815 Cinnabar Place
j Mailing Address Mailing Address
1 Huntersville NC 28078
City State Zip City State Zip
704-875-9704
Telephone Number Telephone Number
9. Indicate Deed Book and Page where deed(s)or instruments)are recorded
Deed Book 4654 Page 2441
Deed Book Page
10. Tax Map No. 3574937069 Block Lot No.
flECEIVEIrI
APR 0 1 2623
Page I
BY:

PART B:
1. Person(s)or firm(s)who are financially responsible for this land-disturbing activity
VCM Bowman, LLC
Name Name
13815 Cinnabar Place
Mailing Address Mailing Address
Huntersville NC 28078
City State Zip City State Zip
704-875-9704
Telephone Number Telephone Number
2. If the Financially Responsible Party is not a resident of North Carolina, give name and street
address of a North Carolina agent.
Name
Mailing Address Street Address
City State Zip Telephone Number
3. 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 Part is a Corporation give name and street address of the Registered Agent.
Name
Mailing Address Street Address
City State Zip Telephone Number
4. 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 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.
,r 9 eriT docokti3O,0 9X�r►G�i�
Type or Print Name Title or Authority
3//,)Ab
ignature Date
• . , a Notary Public of the County of GA.MM , State of North
Carolina, hereby certify that Vogel,'Q `3.,�w.A0 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 I9 day of acEt , 2020
I \\o\o ps P sM,,1/4 � 3- 2 3. 2 G 2 q
Notary .• 0 SEAL •y p,My Commission Expires
���� ✓'�'�� File:Financial Responsibility-Ownership Form.mw
Notary Public
Gaston County zPage 2
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