NCC242415_FRO Submitted_20240808

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
402C003
1.Project Name*
1 Project Hoist
2.Location of land-disturbing activity(Highway/Street)*
0 Summit Park Drive
Latitude Longitude
3..1pproximate date land-disturbing activity will be commenced
7/1/2024
4.Purpose of development(residential,commercial,industrial,etc.)
Industrial
5.Apprtixiniate acreage of land to be disturbed or uncovered'''
13.88 ac
6.Person to contact should sediment control issues arise during land-disturbing activity" Cell Phone Number'
Maggie Houston 704-926-1403
"this information will be made available on the Rowan County Planning&Development webslte.
Email Address
[e-mail]
7.Landowner of Record Landowner of Record
Rowan County
Name Name
Current Mailing,Address Current Flailing Address
130 W Innes St
Salisbury,NC
8.Recorded in Deed Book Number Page Number
231 7
Part B

I.Person or Firm ssho are financially responsible for this land-disturbing activity Person or Finn who are financially responsible for this land-disturbing activity
BEACON ACQUISITIONS LLC
III
Name of Person(s)or Firm(s) Name of Person(s)or Firm(s)
Current Mailing Address Current Mailing Address
500 E MOREHEAD ST,SUITE 200
CHARLOTTE,NC 28202
Phone Number Phone Number
704-597-7757
a.If the Financially Responsible Party is nun a resident of North Carolina,give name and street address of a North Carolina Agent.
Name of Agent Nante ofigent
•
Current Mailing Address Current Mailing Address
Phone Nnnd,er Phone Number
h.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.II the
Financially Responsible Party is a Corporation,give the name and street address ol'the Registered Agent.
Name of Registered gent
Current Mailing Address Current Street Address
Telephone Number Telephone Number
The above information is true and correct to the best of toy 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 • tttt
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Jon L Morris Manager
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Signature Dam j t 2 3
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.a Noun-) Public of the Count of MeC k�[Y\ U Slate of Noah Carolina,hereby certify that
appetAt•ed p annully brtnre me this day'and bring dui)s%surn aclmovileilgoi that list: form o as executed by himiher.Nituess m�hand nn s tl cut of Nulul•y'.this It*day
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