Loading...
HomeMy WebLinkAboutNCC221132_FRO Submitted_20220322FINANCIAL 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. 1. Project Name Wheatfield Subdivision Ph 1 - Sec 2 2. Location of land -disturbing activity: County_ Iredell City or Township Chambersburg Highway/Street Ostwalt Amity Rd Latitude 35.700722 Longitude-80.808575 3. Approximate date land -disturbing activity will commence: lebruary 2022 4 5 Purpose of development (residential, commercial, industrial, institutional, etc.): Residential Total acreage disturbed or uncovered (including off -site borrow and waste areas): 6.22 aC 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 NZ No Enclosed 8. Person to contact should erosion and sediment control issues arise during land -disturbing activity: Name Matthew Silmser E-mail Address mjsilmser@gmail.com Telephone Cell # 336-362-1748 Fax # 9. Landowner(s) of Record (attach accompanied page to list additional owners): MJ Silmser Corp _ 336-362-1748 Name YZ PS Telephone Fax Number Current Mailing Address Z70 24 Current Street Address NC City State Zip City State Zip 10. Deed Book No. 2477 Page No. 1415 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): MJ Silmser Corp _ Name Current Mailing Address City NC mjsilmser@gmaii.com E-mail Address Current Street Address State Zip City Telephone 336-362-1748 Fax Number. State Zip Page 1 of 2 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 E-mail Address Current Mailing Address Current Street Address City State Zip City Telephone 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 information should there by any change in the information provided herein. Matthew Silmser Type or pr4,gUp e Sign�at`ure President Title or Authority Date I, L[ VUAA h ` )OVVI V t a Notary Public of the County of �> I UMV - I M 4 A State of North Carolina, hereby certify that �/ M�'t,P,_ _ 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 ,,� day of 20 ' A AJA ILY BOWMAN Notary Seq4otary Public Stokes Co., North Carolina My Commission Expires June 6, 2026 My commission expires Page 2 of 2