NCC242955_FRO Submitted_20240925

FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
SEDIMENTATION POLLUTION CONTROL ACT
EXPRESS PERMITTING OPTION
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 Meribel
2. Location of land-disturbing activity: County Buncombe City or Township Weaverville
82.5835
Highway/Street171 Monticello Latitude(decimaldegrees) 35.7035 Longitude(decimaldegrees) ---_
3. Approximate date land-disturbing activity will commence:Spring 2024
4. Purpose of development(residential, commercial, industrial, institutional, etc.): Residential
5. Total acreage disturbed or uncovered (including off-site borrow and waste areas): 9
6. Amount of fee enclosed $2,900 . The Express Permitting application fee is a dual charge.
The normal fee of$100.00 per acre (rounded up to the next acre) is assessed without a ceiling amount.
In addition,the Express Permitting supplement is$250 per acre up to eight acres,after which the Express
Permitting supplemental fee is a fixed$2,000.00 (Example:8.10-acre application fee is$2,900). Checks
should be addressed to NCDEQ.
7. Has an erosion and sediment control plan been filed? Yes❑ Enclosed ❑x No D
8. Person to contact should erosion and sediment control issues arise during land-disturbing activity:
Name Landon Cox E-mail Address [e-mail]
Phone: Office# 502-638-0534 Mobile# [phone]
9. Landowner(s)of Record (attach accompanied page to list additional owners):
Orva Lee Roberts Et Al �5)Z73 - 335c>
Name Phone: Office# Mobile#
34 Mountain Meadow Circ 34 Mountain Meadow Circ
Current Mailing Address Current Street Address
Weaverville NC 28787 Weaverville NC 28787
City State Zip City State Zip
Page No.01 97
10. Deed Book No.0233 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).
LDG Multifamily, LLC [e-mail]
Company Name E-mail Address
212 South Tryon Street Suite 1000 212 South Tryon Street Suite 1000
Current Mailing Address Current Street Address
Charlotte, NC 28281 Charlotte, NC 28281
City State Zip City State Zip
Phone: Office# 502-638-0534 Mobile# [phone]
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:
Cogency Global [e-mail]
Name of Registered Agent E-mail Address
212 South Tryon Street Suite 1000 212 South Tryon Street Suite 1000
Current Mailing Address Current Street Address
Charlotte, NC 28281 Charlotte, NC 28281
City State Zip City State Zip
Phone: Office#[phone] Mobile#
Norma Coreas
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
(d) If order to facilitate Express 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:
Kimley-Horn and Associates [e-mail]
Engineering firm or other consultant E-mail Address
Ashton Smith 984-275-3905
Individual contact person (type or print) Phone: Office# Mobile#
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.
Chris Dischinger Member
Type or print name Title or Authority
04� I 10/6/23
Signature / Date
Jill Jones , a Notary Public of the County of Jefferson
State of Kentucky, hereby certify that Chris Dischinger appeared personally
before me this day and being duly sworn acknowledged that the above form was executed by him/
her. 6th October 23
Witness my hand and notarial seal, this , 20-
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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:
NORTHRIDGE COMMONS TOWNHOMES OWNERS ASSOCIAITON INC (P-8)717,or7 I
Name Phone: Office# Mobile#
PO BOX 1157 PO BOX 1157
Current Mailing Address Current Street Address
Arden, NC 28704 Arden, NC 28704
City State Zip City State Zip
Deed Book No.6016 Page No.0460 Provide a copy of the most current deed.
Landowner 3 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.
Landowner 4 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.
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.

Continued from Item 1 in Part B of the Financial Responsibility/Ownership Form for multiple parties.
Attach copies of this page as needed to list all financially responsible parties.
Company 2 Name E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Phone: Office# Mobile#
Company 3 Name E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Phone: Office# Mobile#
Company 4 Name E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Phone: Office# Mobile#
Company 5 Name E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Phone: Office# Mobile#