NCC241990_FRO Submitted_20240701

PLAN REVIEW/FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
CATAWBA COUNTY CODE OF ORDINANCES, CHAPTER 16 ARTICLE V
SOIL EROSION AND SEDIMENTATION CONTROL
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 Catawba County
Utilities and Engineering Department. (Please type or print, and if question is not applicable, please N/,4 in the blank)
PART A
1. Job Name 'OXFORD GLEN DEVELOPMENT
2. PIN or 911 Address 37630483423;376304948473;377303038412;377303049320
3. Purpose of development(residential, commercial, industrial, institutional,etc.)IRESIDENTIAL
4. Approximate soil disturbance date 106/01/2024
5. Total acreage disturbed or uncovered (including off-site borrow and waste areas) 144 ACRES
6. Has an erosion and sedimentation control been tiled'? E Yes {--' No lX Attached
7. If you have an Erosion Control billing account, would you like this to be billed? r Yes 1 No
Account Number l
PEOPLE
8. Person to contact should erosion and sediment control issues arise during land-disturbing activity
Name T1NA Little E-mail address frlNA.TOWNEBUILDER@OUTLOOKCQM
Telephone [phone] Cell # I Fax # I
9. Landowner(s) of Record (attach accompanied page to list additional owners)
Name'LANEY BARBARA HUNSUCKER Telephone I Fax #
Current Mailing Address 12776 PLAYER CIR
City 'CONOVER State INC
Zip 128613
. . . .. .........._....
Current Street Address ISAmE
City I State [ Zip
10. Deed Book No. 13712 Page No. 1719
PART B
1. Person(s) or firm(s) who arc financially responsible for the land-disturbing activity (Provide a comprehensive list
of all responsible parties on attached sheet):
Name JVR FARMS LLC E-mail address [e-mail]
Current Mailing Address 17271 LONG ISLAND ROAD
City 'CATAWBA State INC ]
Zip 128609

Current Street Address ISAmE
City I State Zip
Telephone J Fax# !
2. (a) If the financially responsible party is not a resident of North Carolina, give name and street address of the
designated North Carolina Agent:
Name I E-mail address I
Current Mailing Address I
City I State Zip
Current Street Address
j
City I State Zip 9
Telephone 1 Fax # f
2. (b) If the financially responsible party is a Partnership or other person engaging in business under assumed name,
attach a copy of the Certificate of Assumed Name. If the financially responsible party is a Corporation, give name
and street address of the Registered Agent:
Name I E-mail address I
Current Mailing Address l
City I State Zip 1
Current Street Address 1
City I State Zip
Telephone I Fax# I
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 the 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.
T e ame Title of Authcf ity
Signature Dat
I,_/.1V/I e 1:il/t , a Notary ublic of the County of (iA > 4 j*' A- State of North
Carolina, hereby certify that ,��Jti Qa0Y14/ Sit- appeared personally before me this day and being duly
sworn acknowledge that the ahoui fonn was xecuted by him.
Witness my hand and not iry seal. this /3'4 day of �� 2O�y
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NOTARY My Commission expires �—
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