NCC241766_FRO Submitted_20240610

FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
SEDIMENTATION POLLUTION CONTROL ACT
No person may initiate any land-disturbing activity on one or more acres as covered by the Act before this form
and an acceptable erosion and sedimentation control plan have been completed and approved by the Land
Quality Section, N.C. Department of Environmental Quality. Submit the completed form to the appropriate
Regional Office. (Please type or print and, if the question is not applicable or the e-mail address or phone
number is unavailable, place N/A in the blank.)
Part A.
1. Project Name Cameron Pines
2. Location of land-disturbing activity: County Brunswick City or Township n/a
Highway/Street Jenrette Rd SW Latitude(decimal degrees)33'92 Longltude(decimal degrees)-78 47
3. Approximate date land-disturbing activity will commence:April 2024
4. Purpose of development (residential, commercial, industrial, institutional, etc.): Residential
5. Total acreage disturbed or uncovered (including off-site borrow and waste areas): 37.8 ac
6. Amount of fee enclosed: $3,800.00 . The application fee of$100.00 per acre (rounded
up to the next acre) is assessed without a ceiling amount (Example: 8.10-acre application fee is $900).
Checks should be addressed to NCDEQ.
7. Has an erosion and sediment control plan been filed? Yes❑ Enclosed ❑x No ❑
8. Person to contact should erosion and sediment control issues arise during land-disturbing activity:
Name Nathan Pound, PE E-mail Address [e-mail], [e-mail]
Phone: Office# [phone] Mobile# [phone]
9. Landowner(s)of Record (attach accompanied page to list additional owners):
JENRETTE CURTIS AND JENRETTE CHARLES
Name Phone: Office# Mobile#
46728 MERION CIR
Current Mailing Address Current Street Address
NORTHVILLE, MI 48168-8489
City State Zip City State Zip
10. Deed Book No.02017 Page No. 0799 Provide a copy of the most current deed.

Part B.
1. Company(ies)who are financially responsible for the land-disturbing activity(Provide a comprehensive list
of all responsible parties on accompanied page.) If the company is a sole proprietorship or if the landowner(s)is
an individual(s), the name(s)of the owner(s)may be listed as the financially responsible party(ies).
Lennar Carolinas, LLC [e-mail]
Company Name E-mail Address
13589 21 st Avenue, Suite 105 same
Current Mailing Address Current Street Address
North Myrtle Beach SC 29577 same
City State Zip City State Zip
Phone: Office# 843-901-8360 Mobile# same
Note: If the Financially Responsible Party is not the owner of the land to be disturbed, include with this form
the landowner's signed and dated written consent for the applicant to submit a draft erosion and sedimentation
control plan and to conduct the anticipated land disturbing activity.
2. (a) If the Financially Responsible Party is a domestic company registered on the NC Secretary of State
business registry, give name and street address of the Registered Agent:
Name of Registered Agent E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Phone: Office# Mobile#
Name of Individual to Contact(if Registered Agent is a company)
(b) If the Financially Responsible Party is not a resident of North Carolina, give name and street address
of the designated North Carolina agent who is registered on the NC Secretary of State business registry:
Name of Registered Agent E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Phone: Office# Mobile#
Name of Individual to Contact(if Registered Agent is a company)

(c) If the Financially Responsible Party is engaging in business under an assumed name, give name under
which the company is Doing Business As. If the Financially Responsible Party is an individual, General
Partnership, or other company not registered and doing business under an assumed name, attach a copy
of the Certificate of Assumed Name.
Company DBA Name
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(s)
or his attorney-in-fact, or if not an individual, by an officer, director, partner, or registered agent with
the authority to execute instruments for the Financially Responsible Party). I agree to provide
corrected information should there be any change in the information provided herein.
cic;1? g1ReCTGR. ()5 LAK)D I 'V C-Lo QME;k)r
Type or print name Title or Authority
3/I cl [20 9'4-
Signature Date
I, W/noLE fiRuce , a Notary Public of the County of kaRRY
S ru
State of Pftirth Carolina, hereby certify that 3R\AK) ?Af R. appeared personally
before me this day and being duly sworn acknowledgedc that the above form was executed by him/her.
Witness my hand and notarial seal, this I day of MARC_O , 20 a 4'
Nicole Bruce Notary
Notary Public
State of South Carolina My commission expires ii 071 aD, 0Q
My comm. expires 11/21/2032

Continued from Items 9 & 10 in Part A of the Financial Responsibility/Ownership Form for multiple
owners. Attach copies of this page as needed to list all landowners.
Landowner 2 of Record:
JENRETTE CHARLES OTIS ETALS
Name Phone: Office# Mobile#
46728 MERION CIRCLE
Current Mailing Address Current Street Address
NORTHVILLE, MI 48168
City State Zip City State Zip
Deed Book No.00634 Page No. 0062 Provide a copy of the most current deed.
Landowner 3 of Record:
JENRETTE ANTHONY E
Name Phone: Office# Mobile#
3526 FRAY LANE
Current Mailing Address Current Street Address
LONGS, SC 29568
City State Zip City State Zip
Deed Book No.03791 Page No. 1261 Provide a copy of the most current deed.
Landowner 4 of Record:
JENRETTE CHARLES OTIS ETAL
Name Phone: Office# Mobile#
46728 MERION CIRCLE
Current Mailing Address Current Street Address
NORTHVILLE, MI 48168
City State Zip City State Zip
Deed Book No.00585 Page No. 0804 Provide a copy of the most current deed.
Landowner 5 of Record:
Name Phone: Office# Mobile#
Current Mailing Address Current Street Address
City State Zip City State Zip
Deed Book No. Page No. Provide a copy of the most current deed.