NCC243294_FRO Submitted_20241106

FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
EROSION & SEDIMENTATION CONTROL
T-R E D E L 1.- No person may initiate any land-disturbing activity on one or more acres, '% acre or more inside a
r ci-' N r_v': 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.
I. Project Name L'Attitude 35-Lake Norman Subdivision
2. Location of land-disturbing activity: County Iredell City or Township Mooresville
Deerwood Ln.and
Highway/Street Foursquare Rd. Latitude 35°33'56.50"N Longitude 80°50'46.39"W
3. Approximate date land-disturbing activity will commence: Late Summer 2024
4. Purpose of development(residential, commercial, industrial, institutional,etc.): Residential
5. Total acreage disturbed or uncovered(including off-site borrow and waste areas): 72 Acres
6. Amount of fee enclosed:$ 12,600.00 An application fee of$175.00 per acre(rounded up to the next acre)is
assessed without a ceiling amount (Example: a 8.10-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$100.00 is assessed.
7. Has an erosion and sediment control plan been filed? Yes No Enclosed X
8. Person to contact should erosion and sediment control issues arise during land-disturbing activity:
Name Brian Macho E-mail Address [e-mail]
Telephone [phone] Cell# Fax#
9. Landowner(s)of Record(attach accompanied page to list additional owners):
Mooresville BTR Developers, LLC 937-475-2909
Name Telephone Fax Number
1 Town Center Rd.; Suite 675 1 Town Center Rd.; Suite 675
Current Mailing Address Current Street Address
Boca Raton, FL 33486 Boca Raton, FL 33486
City State Zip City State Zip
10. Deed Book No. Page No. Provide a copy of the most current deed.
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):
Mooesville BTR Developers,LLC [e-mail]
Name E-mail Address
1 Town Center Rd.; Suite 675 1 Town Center Rd.; Suite 675
Current Mailing Address Current Street Address
Boca Raton, FL 33486 Boca Raton, FL 33486
City State Zip City State Zip
Telephone [phone] Fax Number
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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:
David Coble [e-mail]
Name E-mail Address
111 Timberfalls Ct. 111 Timberfalls Ct.
Current Mailing Address Current Street Address
Mooresville NC 28115 Mooresville NC 28115
City State Zip City State Zip
Telephone [phone] 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
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.
Patrick® Manager
Type or print na'', Title or Authority
4/i 7/3/2024
Sig ,ice ' Date
I, Sarah Spangler , a Notary Public of the County of Dallas
State of North Carolina, hereby certify that Patrick Marino appeared personally before me this day
and being duly sworn acknowledged that the above form was executed by him.
Witness my hand and notarial seal, this 3rd day of July , 2024
. -37/-. --
Notary
Seal
My commission expires 03/24/2028
s)e:e.,.P"'( SARAH SPANGLER
`� VB
_r°; _Notary Public,State of Texas
;.'• r; Comm.Expires 03-24-2028
�''',nu&�� Notary ID 130595024 `
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