NCC241182_FRO Submitted_20240422

°°°N''� Gaston County
R.
Gaston Natural Resources Department
9_21303 Cherryville Highway, Dallas, NC 28034 Telephone: [phone]
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r,- Soil Erosion & Sedimentation Control
Financial Responsibility/Ownership
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 Little Long Creek SF
2. Location of land-disturbing activity
City Dallas Highway/Street Dallas High Shoals Hwy
3. Approximate date land-disturbing activity will commence 06/2023
4. Purpose of development(residential, commercial, industrial, etc.) Residential
5. Total acreage disturbed or uncovered (including off-site borrow and waste areas) 146 ac
6. Amount of fee enclosed $ 43,800
7. Soil Erosion & Sedimentation Plan Filed? Yes X No
8. Landowner(s)of Record (Use blank page to list additional owners)
LGI Homes- NC, LLC.
Name Name
1450 Lake Robbins Drive, Ste 430
Mailing Address Mailing Address
The Woodlands TX 77380
City State Zip City State Zip
704-634-0644
Telephone Number Telephone Number
9. Indicate Deed Book and Page where deed(s) or instrument(s)are recorded
Deed Book 5298 Page 2157
Deed Book Page
10. Tax Map No. Block Lot No.
Page 1

PART B:
1. Person(s)or firm(s)who are financially responsible for this land-disturbing activity
LGI Homes-NC, LLC
Name Name
3037 Sherman Drive
Mailing Address Mailing Address
Lancaster SC 29720
City State Zip City State Zip
704-634-0644
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.
LGI Homes- NC, LLC.
Name
2626 Glenwood Avenue, Suite 550
Mailing Address Street Address
Raleigh NC 27608 704-634-0644
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.
Jeff Webb VP of Development
Type or P ' ame Title or Authority
Ult-li - 11- Zl - 2Z-2,-2-
ig ature Date
I, VC) Al L ✓itSSR- , a Notary Public of the County of �/,1I1 il(q , State of North
Carolina, hereby certify that 4/C6 appearedpersonally before me this day
and being duly sworn acknowled d tFfat the above form_WWas e ecuted by him.
-ss my hand and notarial seal, this ,,gyp""" iy,Af Nod2/r�cIlia , 2 OiL .
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