HomeMy WebLinkAboutNCC216300_FRO Submitted_20211112town of niumil;eli sville
Soil Erosion & Sedimentation Control Ordinan
NCMTH CAROLINA Financial Responsibility/Ownership Form
No person shall initiate any land -disturbing activity as defined in the Town of' Huntersville Soil
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of Huntersville. The financially responsible party will be on record as the party to receive any
Notices of Violation or related documents related to non-compliance issues with the above
Ordinance. By ng this form, the parties are not relieved from any other permits that may be
required for the Proiect. Ifithe financially responsible partv is out of State, a North Carolina aqent
must be assigned.
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1. Project where land -disturbing activity is �ILO be undertaken:
2. Address of land -disturbing activity: 14418 NC Hwy 73, Huntersville NC 28078
3. Approximate date land -disturbing activity will commence:
1, Al DYear ay
4. Purpose of development (Residential, Commercial, industrial, etc.): COM I rn, iel-ill
5. Approximate acreage of land to be disturbed or uncovered: 3.43 acres
C. Total site acreage: 10.77
7. Landowners of record (use blank pages to list additional owners as necessary)
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Owner #1 Name: C.'assrows Laind, LU—'
Address: 15550 to town Road, Huntersville NC 28078
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additional deeds or instruments as necessary)
--A 756 922
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Financial
Financial Responslibillity/Owiership For - Col-1401nued
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Persons or Firm: Irassroots Land, LLC
Address: 15550 Stumptown Rd, Huntersville NC 28078
Telephone.- 7 ; L-1 -12-5; 61 (rFax:
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Person or Firm:
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3. The above information is true and correct to the best of my knowledge and belief and was
provided by me while under oath. (This form must be signed by the financially responsible
person is an individlUall ON by an officer, director m�i4�^r �
Wi, HC.-I L! 11U!, attor, ey-in-fact, or ot.her person
with authority to execute instruments for the financially responsible company or entity, if not
an individual)
....-ed Name Title
Date
om' M'Nfonr ff
GA -'iWLCA1'Y
Public of the County of
Z i llf,Lk 1.14 State of hereby
certify that I i personally appeared
before me on this day and under oath acknowledged that this form was executed by him/her.
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W ness my humnd and notarial! s-1 this day of 2' id
IMEMEMEM
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w�--o"untersv'11-
PO Box 664
10-1-, Gilea d Rd.,. Ste 300
Huntersville, NC -MM