NCC240656_FRO Submitted_20240314

co Pitt County
�tifi �' �� Planning Department
4 Development Services Building
�o 1717 W. 5th Street
cAgo` Greenville, North Carolina 27834-1696 James F.Rhodes,AICP
Telephone: [phone] Director
Fax: [phone]
Financial Responsibility / Ownership Form
Soil Erosion and Sedimentation Control Ordinance
No person may initiate any land-disturbing activity on one or more contiguous acres as
covered by the Act before this form and an acceptable erosion and sedimentation control plan
have been completed and approved by the Pitt County Planning Department. (Please type or
print and, if question is not applicable, place N/A in the blank.)
Part A.
1. Project Name DAIL FARMS SUBDIVISION
2. Location of land-disturbing activity: County PITT
City or Township ARTHUR , and Highway/Street NASH JOYNER RD
3. Approximate date land-disturbing activity will be commenced: 3/15/24
4. Purpose of development (residential, commercial, industrial, etc.):
RESIDENTIAL
5. Approximate acreage of land to be disturbed or uncovered: 19 AC
6. Has an erosion and sedimentation control plan been filed? Yes X No
7. Person to contact should sedimentation control issues arise during land-disturbing-activity:
Name LINDSEY TRIPP Telephone [phone]
8. Landowner(s) of Record (Use blank page to list additional owners):
NASH JOYNER LLC
Name(s) Name(s)
4158 NORRIS STORE RD
Current mailing address Street address
AYDEN NC 28551
City State Zip City State Zip
9. Recorded in Deed Book No. 4252 Page No. 285
Part B.
1. Person(s) or finn(s) who are financially responsible for this land-disturbing activity (Use
the blank page to list additional persons or firms):
NASH JOYNER LLC LINDSEY TRIPP
Name of person(s)or Firm(s) Name(s)
4158 NORRIS STORE RD 4158 NORRIS STORE RD
Current mailing address Street Address
AYDEN NC 28551 AYDEN NC 28551
City State Zip City State Zip
252-746-9278 252-746-9278
Telephone Telephone

2. (a) If the Financially Responsible Party is a Corporation, give name and street address of
the Registered Agent.
Name(s)
Current mailing address Street Address
City State Zip City State Zip
Telephone Telephone
(b) If the Financially Responsible Party is a Partnership give the name and street address
of each General Partner(Use blank page to list additional partners):
Name(s) Name(s)
Current mailing address Current mailing address
City State Zip City State Zip
Telephone Telephone
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/her 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.
// ma's _/
i
Ty. Prin •, •e Ti o Au ority
911/a2
Signature Date
I, Q v P- • ` � , a Notary Public of the County of (4+ State
of N Carolina, hereby
r by certify that �,� c\r- , )(--_) \kr \9Sj
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 \ day of 'CC-\-1 .
Cy6At _.)
Notary
My commission expires '1
JEAN H.TFIPP
NOTARY PUBLIC
PITT COUNTY
STATE OF NORTH CAROLIN,.