NCC243283_FRO Submitted_20241113

FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
EROSION & SEDIMENTATION CONTROL
IREDELL No person may initiate any land-disturbing activity on one or more acres, '/7 acre or more inside a
c u u N r v NC 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.
Circle Tracks Warehouse
1 Project Name
2 Location of land-disturbing activity. County Iredell City or Township Mooresville
Highway/Street Overhill Rd Latitude 35.5995 Longitude-80.84827
3 Approximate date land-disturbing activity will commence. September. 2024
4 Purpose of development(residential, commercial, industrial, institutional. etc.): Commercial
5 Total acreage disturbed or uncovered (including off-site borrow and waste areas): 1.15 Acres
6. Amount of fee enclosed: $ 550.00 An application fee of$275.00 per acre(rounded up to the next acre) is
assessed without a ceiling amount (Example a 8.10-acre application fee is $2475). 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 Sam King, Jr. E-mail Address [e-mail]
Telephone [phone] Cell# 828-403-5586 Fax#
9 Landowner(s)of Record (attach accompanied page to list additional owners).
M2 Investments of Race City, LLC 813-843-2221
Name Telephone Fax Number
107 Overhill Drive 107 Overhill Drive
Current Mailing Address Current Street Address
Mooresville, North Carolina 28711 Mooresville, North Carolina 28711
City State Zip City State Zip
10. Deed Book No. 3078 Page No. 1235 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),
M2 Investments of Race City, LLC
Name E-mail Address
107 Overhill Drive 107 Overhill Drive
Current Mailing Address Current Street Address
Mooresville, North Carolina 28711 Mooresville, North Carolina 28711
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:
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:
Laila Rogers
Name of Registered Agent E-mail Address
290 Cove Creek Loop 290 Cove Creek Loop
Current Mailing Address Current Street Address
Mooresville, North Carolina 28711 Mooresville, North Carolina 28711
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.
Laila Ro•ers President
Type or prin t me Title or Authority
I �L
Signature D te
) fTC��i�a_ , a Notary Public of the County of �C v..
State of North Carolina, hereby certify that fa— appeared personally before me this day
and being duly sworn acknowledged that the above form was a*ecuted by hirrr.he,-
Witness my hand and notarial seal,this 2 - day of Atk at , 20,2.44-
S4,tn. .
Notary
Seal
My commission expires ((!IC/2o;•/1
SANDY R GOBBLE
Notary Public, North Carolina
Rowan County
My Commission Expires
S.l+ Ind 2.02''1
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