NCC241906_FRO Submitted_20240711

SOIL EROSION and SEDIMENTATION CONTROL
Lincoln County Natural Resources Department
4:41
:� a 115 West Main Street, Lincolnton, NC 28092 704-736-8501 Fax: [phone]
\FI'_
FINANCIAL RESPONSIBILITY / OWNERSHIP FORM
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 has been completed and approved by the Lincoln County Natural Resources Department.
(Please type or print. If the question is not applicable or the e-mail and/or fax information unavailable, place N/A in the blank.)
Part A
1. Project Name Sittord Farms
2. Location of land-disturbing activity: Latitude 35.4220091 Longitude -80.9855495
Parcel Identification Number(PIN)_ see attached Watershed Area Johnson Creek
Highway/StreetAddress 7639Sifford Rd. Stanley, NC 28164
3. Approximate date land-disturbing activity will commence: 4/18/24
4. Purpose of development(residential,commercial,industrial,institutional,etc.): Residential
5. Total acreage disturbed or uncovered(including off-site borrow and waste areas): 15.93
6. Amount of fee enclosed: $ 3,200.The Standard Permitting application fee of$200.00 per acre(rounded up to
the next acre)is assessed without a ceiling amount(Example: 9 acres total $1,800). The Express Permitting
application fee is a dual charge.The normal fee of$200.00 per acre (rounded up to the next acre) is assessed
without a ceiling amount. In addition,the Express Permitting supplement is$250.00 per acre up to eight acres, after
which the Express Permitting supplemental fee is a fixed$2,000 00 (Example: 9 acres total S3,800.00)
7 Has an erosion and sediment control plan been filed? Yes X No Enclosed
8. Local appointed person to contact should erosion and sediment control issues arise during land-disturbing activity:
Name Bill Rice _E-mail Address [e-mail]
Telephone Cell# 704-309-1552 Fax#
9. Landowner(s)of Record(attach accompanied page to list additional owners):
Century Communities Southeast LLC 704-216-1666
Name Telephone Fax Number
7400 Cannel Executive Park Dr,Ste 205 7400 Cannel Executive Park Dr,Ste 205
Current Mailing Address Current Street Address
Charlotte NC 28226 Charlotte NC 28226
City State Zip City State Zip
10. Deed Book No.3305 Page No. 724-726 most recently filed in Lincoln County Register of Deeds
11 Future Landowner(s) if applicable: (attach accompanied page to list additional owners):
N/A
Name Telephone Fax Number
Current Mailing Address Current Street Address
City State Zip City State Zip

)111*; SOIL EROSION and SEDIMENTATION CONTROL
Lincoln County Natural Resources Department
115 West Main Street, Lincolnton, NC 28092 704-736-8501 Fax: [phone]
FINANCIAL RESPONSIBILITY / OWNERSHIP FORM
Part B
Person(s)or firm(s)who are financially responsible for the land-disturbing activity(Provide a comprehensive
list of all responsible parties on an attached sheet):
Century Communities of Southeast LLC
Name E-mail Address
7400 Carmel Executive Park Dr, Ste
205 7400 Carmel Executive Park Dr, Ste 205
Current Mailing Address Current Street Address
Charlotte NC Charlotte NC
City State City State
Telephone [phone] Fax Number
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 E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Telephone _ _ Fax 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 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
Telephone Fax Number
(c) In order to facilitate Permitting, it is necessary to be able to contact the Engineer or other consultant who can
assist in providing any necessary information regarding the plan and its preparation:
Path Light Pro dringel@pathlightpro corn
Engineering Firm or other consultant E-mail Address
1511 E State Rd 434 Ste 3001 Winter Springs FL 32708
Current Mailing Address City State Zip
Dina Ringel
704-340-2055
Individual contact person(type or print) Telephone Fax Number

• ' ,, SOIL EROSION and SEDIMENTATION CONTROL
Lincoln County Natural Resources Department
t_5 115 West Main Street, Lincolnton, NC 28092 704-736-8501 Fax: [phone]
ferair
FINANCIAL RESPONSIBILITY / OWNERSHIP FORM
(d) Contractors and/or Subcontractors (person(s)or firm(s)engaging in the land-disturbing activity:
Name of Person or Firm Name of Person or Firm
Current mailing Address Current Street Address
City State Zip City State Zip
Individual contact person(type or print) Individual contact person (type or print)
Telephone Telephone_
Fax Number Fax 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 the authority to execute instruments for the Financially
Responsible Person). I agree to provide corrected information should there by any change in the information provided
herein and any other associated documents. I understand that all documents that are associated with this project and
project number are parts of the complete project document.
Permission to Enter on Land
I certify that I am authorized to grant and do in fact grant permission to the Natural Resources Erosion Control Inspector
an his agents t enter on the land in question in connection and/or related to this permit.
tJ�- I,112G11t�+� 600we. V•P. LAk Div • ANC nh01-}5
Typ: or pri ame Title or Authority
4Apt_______ 4111\20Z4
Sig I. Date 1
I, Eli 7x000 Qo(ur -RC , a Notary Public of the County of ) �L' WO.Lj
State of North Carolina, hereby certify that t- 111( YArrseliln6,7 appeared personally before
me this day and being duly sworn acknowledged tha he above form was executed by him.
Witness my hand and notarial seal,this � day of >'[ ,202.1.1
�� t PhQc
Notary
`` Pg C/,L�.,��� My commission expires 1115 ' Zit(
v Notary Public 9P II
to Mecklenburg m
County =
My Comm. Exp.
��2O 12-15-2024 Q
sils
��''i�„,y'CAR10V`\'