NCC242875_FRO Submitted_20240918

FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
( �_ EROSION & SEDIMENTATION CONTROL
IRE D EL L I No person may initiate any land-disturbing activity on one or more acres, '/2 acre or more inside a
[. O U N 1 Y N C
watershed, as covered by the Sedimentation Pollution Control Act and the Iredell County Land
Development Code, before an acceptable erosion and sedimentation control plan has been submitted
and approved by the Iredell County Planning & Development, Erosion Control Section.
(Please type or print.)
Part A.
1. Project Name Rinehardt Road Subdivision
2. Location of land-disturbing activity: County Iredell City or Township Mooresville
Highway/Street Rinehardt Road Latitude 35 35'43.3" Longitude 80 49'41.3"
3. Approximate date land-disturbing activity will commence: 10-1-2024
4. Purpose of development(residential,commercial, industrial, institutional, etc.): Residential Subdivision
5. Total acreage disturbed or uncovered (including off-site borrow and waste areas): 95.44
6. Amount of fee enclosed: $ N/A . An application fee of$175.00 per acre(rounded up to the next acre)is
assessed without a ceiling amount (Example: a 9-acre application fee is $1575). For projects > than 0.5 acres but no
greater than 0.99 acres in a water supply watershed,a flat fee of$135.00 is assessed.
7. Has an erosion and sediment control plan been filed? Yes X No Enclosed
8. Person to contact should erosion and sediment control issues arise during land-disturbing activity:
Name Jeremy Horton, PE E-mail Address JHORTONMIHOMES.COM
Telephone [phone] Cell# Fax#
9. Landowner(s)of Record(attach accompanied page to list additional owners): See attached for multiple parcels
M T LAND LLC [phone]
Name Telephone Fax Number
141 Providence Road 141 Providence Road
Current Mailing Address Current Street Address
Charlotte, NC 28207 Charlotte. NC 28207
City State Zip City State Zip
10. Deed Book No. Page No. Provide a copy of the most current deed.
See attached for multiple parcels
Part B.
1. 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):
MI Homes of Charlotte, LLC JHORTON co, IHOMES,COrN,
Name E-mail Address
5350 77 Center Drive #100 5350 77 Center Drive 100
Current Mailing Address Current Street Address
Charlotte. NC 282' 7 Charlotte, NC 2821 7
City State Zip City State Zip
Telephone (7` `J 97-453S Fax Number
Page 1 of 2

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:
Corporation Service Company JHORTON OAIHOMES.COM
Name of Registered Agent E-mail Address
2626 Glenwood Avenue. Suite 550 2626 Glenwood Avenue, Suite 550
Current Mailing Address Current Street Address
Raleigh, NC 27608 Raleigh, NC 27608
City State Zip City State Zip
Telephone [phone] 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.
Jeremy Horton, PE Director of Land En it errent;
Type or ' t name Title or Authority
---- 9-16-2024
Signat �..4-7 Date
71)...11A-1, ` (: so,Lk- ,a Notary Public of the County o f v,,,,Awil/� -
u State of North Carolina, hereby certify th fl' (-00- appeared personally before me this day
and being duly sworn acknowledged that th bove fo was executed ► im.
Witness my hand a iletarial seal, this Up day of , ,. la, • 4'It-
00 Milli
A i EN A
„ +> SeARy •
a�T
My co-•tWi .ion •xpires I I" 1 )--
% AUBOCI V
iif11111N
Page 2of2