NCC220329_FRO Submitted_20220118

FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
EROSION & SEDIMENTATION CONTROL
No person may initiate any land -disturbing activity on one or more acres, '/2 acre or more inside a
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.
Project Name MOUNTAIN CREEK FARMSTEAD
Location of land -disturbing activity: County IREDELL City or Township TROUTMAN
Highway/StreetRANKIN HILL RD. Latitude 35.640118 Longitude-80.863226
Approximate date land -disturbing activity will commence: 1/1/2022
4. Purpose of development (residential, commercial, industrial, institutional, etc.): Commercial
5. Total acreage disturbed or uncovered (including off -site borrow and waste areas): 6.1 Acres
6. Amount of fee enclosed: $ 1,225 . 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 No Enclosed X
8. Person to contact should erosion and sediment control issues arise during land -disturbing activity:
Name MICHAEL COCO E-mail Address [e-mail]
0
Telephone [phone] Cell #
Landowner(s) of Record (attach accompanied page to list additional owners):
PARKERTOWN HOLDINGS, LLC
Name Telephone
P.O. BOX 3608
Current Mailing Address
MOORESVILLLE, NC 28117
City State Zip
10. Deed Book No. 2465 Page No. 1690
Part B.
Current Street Address
Fax #
Fax Number
City State Zip
Provide a copy of the most current deed.
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):
MICHAEL COCO [e-mail]
Name
180 Atwater Landing Dr.
Current Mailing Address
MOORESVILLLE, NC 28117
City State
Telephone [phone]
E-mail Address
180 Atwater Landing Dr.
Current Street Address
MOORESVILLLE, NC 28117
Zip City State
Fax Number
Zip
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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
Telephone
Fax Number
State Zip
(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
Current Mailing Address
City
Telephone
E-mail Address
Current Street Address
State Zip City
Fax Number
State Zip
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 informations should there by any change in the information provided herein.
--I �deC_ � - -C 1 Flr-2 57, A Q/l�
Type or print name Title or Authority
Signature — Date
------------------------------------------------------------------------------------------------------------------------------------
I, a Notary Public of the County of
State of North Carolina, hereby certify that I 1 �Wci ` Co C—C, 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 ` ` l day of _ L 20 _
aVWjjC3_ &Ma,, 0, Wil
Notary
Seal
A R Y
P UB\,
My commission expires �
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