NCC240379_FRO Submitted_20240213

10/16/23,4:12 PM Rowan County
Financial Responsibility/Ownership Form Sedimentation Pollution Control Ordinance
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 Rowan County
Environmental Management Department.
Part A Parcel ID Number
140 002 140 169
140 003 140 170
140 004 133A099
140 167 133A206
140 168 133A288
1.Project Name*
Landis85 - Phase I
2.Location of land-disturbing activity(Highway/Street)*
Old Beatty Ford Rd
Latitude Longitude
35.5339 -80.5942
3.Approximate date land-disturbing activity will be commenced
03/01/2023
4.Purpose of development(residential,commercial,industrial,etc.)
Industrial
5.Approximate acreage of land to be disturbed or uncovered*
63 acres ($200 plan review + $125/ac = $8,075)
6.Person to contact should sediment control issues arise during land-disturbing Cell Phone Number*
activity*
Ryan Beadle 214-662-9220
*this information will be made available on the Rowan County Planning&Development website.
Email Address
[e-mail]
https://www.rowancountync,gov/FormCenter/Print?formlD=96&Preview=YES&Save=False&savedProgresslD= 1/3

10/16/23,4:12 PM Rowan County
7.Landowner of Record Landowner of Record
Town of Landis John Eckard
Name Name
Current Mailing Address Current Mailing Address
PO Box 8165 1130 Dial Street
Landis, NC 28088 Kannapolis, NC 28083
8.Recorded in Deed Book Number Page Number
1236 / 883 1308 / 565
All other parcels are currently under contract to be sold to financially responsible party. No land
Part B disturbance will occur prior to closing on those parcels.
1.Person or Firm who are financially responsible for this Person or Firm who are financially responsible for this land-
land-disturbing activity disturbing activity
JSC-CCI Landis I, LLC
Name of Person(s)or Firm(s) Name of Person(s)or Firm(s)
Current Mailing Address Current Mailing Address
301 E Tremont Ave, Suite C
Charlotte, NC 28203
Phone Number Phone Number
214-662-9220
a.If the Financially Responsible Party is not a resident of North Carolina,give name and street address of a North Carolina
Agent.
Name of Agent Name of Agent
Current Mailing Address Current Mailing Address
Phone Number Phone Number
https://www.rowancountync.gov/FormCenter/Print?formID=96&Preview=YES&Save=False&savedProgressID= 2/3

10/16/23,4:12 PM Rowan County
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 the name and street
address of the Registered Agent.
Name of Registered Agent
Capitol Corporate Services, Inc.
Current Mailing Address Current Street Address
176 Mine lake Ct, Ste 100 176 Mine lake Ct, Ste 100
Raleigh, NC 27615 Raleigh, NC 27615
Telephone Number Telephone 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 authority to execute instruments for the Financially Responsible Person).
I agree to provide correctional information should there be any change in the information provided herein.
Name Title or Authority
•
Michele Wheeler President and CEO of JSC Manager LLC,its Manager
A
Signature Date
12/22/2023
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14'ol I , C� ii V( ,a Notary Public of the County of WO 05 State of" roi:ria,
hereby certify that im,Aei vJh« / appeared personally before me this day and being duly sworn acknowledged
that the above form was executed by him/her.Witness my hand and seal of Notary,this 2 2 day of jx Cr c✓ ,2013
Notary My commission expires
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HOW G R I E R
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Seal °'a cr Notary Public. State of Texas
=V• Comm.Expires 04-01-2025
Notary ID 2582156
Checklist •
Download a copy of the Erosion and Sedimentation
Control Plan Checklist(PDF),
https://www.rowancountync.gov/FormCenter/Print?formlD=96&Preview=YES&Save=False&savedProgresslD= 3/3