NCC240693_FRO Submitted_20240312

GUILFORD COUNTY FINANCIAL RESPONSIBILITY/
r PLANNING AND DEVELOPMENT OWNERSHIP FORM
�atit�
A Grading Permit must be obtained before initiating any land-disturbing activity over one(1)acre(43,560 square feet).A
Grading Permit Application, this Financial Form, a Grading/Erosion Control Plan, a surety, good for one (I) year, and a
permit fee should be submitted 30 days prior to the planned commencement of the land-disturbing activity.
The above information should be submitted to: Earl E.Davis II-Inspections Division
Guilford County Planning and Development
Post Office Box 3427
Greensboro,N.C.27402(336)641-3334
Please type or print answers to the following:
Date: 1/16/2024
Name of Project: Stoney Creek Phase 2
Location of Project: Grogan Hill Road
Acreage of Land to be Disturbed: 11.42
LATITUDE 36.0807 (In Degrees)LONGITUDE-79.6003 (In Degrees)
Purpose of Activity(street construction,commercial building,parking lot,etc.): Residential Lot Construction
Landowner(s)of record:
Name: Stoney Creek Partners,LLC Name:
Address: 110 Shields Park Drive,Suite A Address:
Kemersville,NC 27284
Telephone: (Home) Telephone: (Home)
(Office) 336-682-1414 (Office)
(Fax) (Fax)
(E-Mail) kat.Nonseleolerradevelopment.com (E-Mail)
Indicate County,Book,and Page where deed or instrument is filed.
Guilford R-8111 2429.2430,2434-2435
County Book Page
The information provided on this form is true and correct to the best of my knowledge and belief and was provided by
me while under oath. This form must be signed by the property owner if an individual. If owned by a company or
corporation, this form must be signed by an officer, director, partner, attorney-in-fact, or other person with authority to
execute instruments for the corporation. If the person financially responsible is not a resident of North Carolina, a North
Carolina agent must be designed. If someone other than the owner is financially responsible, their signature is required
below also.
i4Perk-keleiN L(o 145
Print or Type Name of Individual N.C.Agent's Signature(If applicable)
DR Horton,Inc..Neil Uldrick,D'' n rmwaler C pliance Sp alist III
Title a d Na 1e Con_pany
Additional Fin y ponsi a Party applicable)
er's S nature
No.E2 Grading Permit&Appl. Page 3 of 6
Rev.December 2017

PLEASE READ THE FOLLOWING INFORMATION:
If a Grading Permit is issued it is valid for up to one(I)year from the date it is issued. If circumstances warrant it, it may
be extended for six (6) months after the one(1)year period. Upon written notice the Grading Permit may be revoked for
failure to install devices as shown on the plan in a prompt fashion, or for failure to maintain the devices once they have
been installed. If a Grading Permit is revoked,all other development permits and approvals are withheld until the property
is once again in compliance with Guilford County regulations. Also, upon written notice a Civil Penalty (fine) can be
instigated against the property owner and/or additional Financially Responsible Party (if any) for violations of Guilford
County's Soil Erosion and Sedimentation Control Ordinance. This penalty is up to$5000.00 per day and is assessed daily
for every day the property is in violation.(Interfering with or hampering an inspection can result in a civil penalty without
written notice).
*************************************
STATE OF N bt-CIn Cu iOli n� (0 E S TU
COUNTY OF 6,;\(�,,t c�
a Notary Public of said County and State,do hereby certify that
Vi U A-Intl L L. v A S personally appeared before me this day and under oath acknowle ged reading the
information above amd acknowledged that the above form was executed by him or her.
Witness my hand and official seal,this the 19 day of SuNAu.() ,20...>M
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My Commission Expires: .. ss ioniNfi `e�. ,
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• (ADDITIONAL FINANCIALLY"' 4',04461hLE PARTY SIGNATU
STATE OF Nay\\ (.cc(01;r^-el
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COUNTY OF ( \
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1 1,a Notary Public of said County and State,do hereby certify that
Ne \ VIerr4 personally appeared before me this day and under oath acknowledged reading the information above and
acknowledged that the above form was executed by him or her.
Witness my hand and official seal,this the (1 da 1L /',-4'i 20111
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Notary Pub c ,,,„,"""""",,,,.
My Commission Expires: SAND%'%,,
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No.E2 Grading Permit&Appl. I' � •member ze;..•' Page 4 of 6
Rev.December 2017 •

DocuSign Envelope ID: E641BE21-47BC-43E3-AA33-06F7EDB7A5E1
Landowner-Builder Agreement for Erosion and Sediment Control
Address of Landowner and/or Company 110-A Shield's Park Drive, Kernersville, NC
•
Date of Agreement: 1/1 g/2024
Financially Responsible Party:
Stoney Creek Partners, LLC-Kat Lyons
Contact Name:
Address: 110-A Shields Park Drive,Kernersville,NC
RE: Project Name: Gantwood at Stoney Creek
Guilford County
To Whom It May Concern:
As evidenced by my signature below, this letter gives DR Horton
authority to pursue plan approvals for erosion and sediment control plans for the Project,
Gantwood at Stoney Creek , for land
disturbing activity located at 501 Gantwood Lane . We
also give permission for DR Horton to perform the
following activities on this property:
n Construction
❑ Grading, Land Clearing, and/or Fill
❑ Lot Prepping
❑ Surveying
❑ Temporary Access
❑ Other
336-682-1414 _ / kat.l on leoterradevelo ment.com any questions.
contact me at and/or y @ p with
LANDOWNER, IF PRIVATE PARTY- NOTE: IF LAND IS OWNED BY TWO OR MORE PARTIES, ALL
PARTIES MUST SIGN
�DocuSigbed by:
Stoney Creek Partners, LLC i teik.t
-4433DFCB8F0542E...
Company Name (If applicable)
Kat Lyons Entitlements Director 1/19/2024
Name Title Date
Company Name (If applicable)
Name Title Date