NCC241449_FRO Submitted_20240513

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
070 135
1.Project Name*
Jerry Hunt Super Center Building Addition
2.Location of land-disturbing activity(Highway/Street)*
653 Bendix Drive. Salisbury NC 28146
Latitude Longitude
35.65177 -80.46416
3.Approximate date land-disturbing activity will be commenced
L03-04-2024
4.Purpose of development(residential,commercial,industrial,etc.)
Commercial
5.Approximate acreage of land to be disturbed or uncovered*
1.42 AC.
6.Person to contact should sediment control issues arise during land-disturbing Cell Phone Number*
activity*
336-290-6606
Todd. Hunt
*this information will be made available on the Rowan County Planning 8 Development website.

Email Address
todd@jerryhuntsupercenter . com
7.Landowner of Record Landowner of Record
DHCH LLC
Name Name
Current Mailing Address Current Mailing Address
418 PIEDMONT DR. LEXINGTON, NC 27295
8.Recorded in Deed Book Number Page Number
1379 635
Part B
1.Person or Firm who are financially responsible for this land- Person or Firm who are financially responsible for this land-
disturbing activity disturbing activity
DHCH LLC
Name of Person(s)or Firm(s) Name of Person(s)or Firm(s)
Current Mailing Address Current Mailing Address
418 PIEDMONT DR. LEXINGTON, NC 27295
Phone Number Phone Number
336-249-2591
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
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
Current Mailing Address Current Street Address
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
;David Hunt ember
i
Signatuge Date
m mid d/YYYY
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I, IAmm a4Dy ,a Notary Public of the County of —00.1),(4,s:::,,N State of North Carolina,hereby
certify that bct..018 \-%LLP 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 2.1 day of iIIlta.fek ,2024

Notary My commission expires
mm/dd/yyyy
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Checklist `�; CJQIAV ram,,
Download a copy of the Erosion and Sedimentation Control
Plan Checklist(PDF). 0 czS\,a
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