NCC221168_FRO Submitted_20220330

FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
EROSION & SEDIMENTATION CONTROL
No person may initiate any land -disturbing activity on one or more acres, Ya 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 Evolve at Lake Norman
2. Location of land -disturbing activity: County I REDELL City or township MDORESVILLE
HighwayfStreet 720 RIVER HIGHEWAY Latitude 35.599051 Longitude -84-882378
3. Approximate date land -disturbing activity will commence. July 1' 2022
4. Purpose of development (residential, commercial, industrial, institutional, etc.): VULTI.FAMILY AND TOWNHOMES
5. Total acreage disturbed or uncovered (including off -site Morrow and waste areas): 41 acres
5. Amount of fee enclosed: $ 7175.00 An application fee of $175.00 per acne (rounded up to the next acre) is
assessed without a ceiling amount (Example: a 9-acre application fee is $1575). For projects a 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 le Enciosed
8. Person to contact should erosion and sediment control issues arise during land -disturbing activity:
Name Matt Rogers E-mail Address [e-mail]
Telephone [phone] Cell #
Fax #
9. Landowner(s) of Record: (attach accompanied page to list additional owners):
Mooresville Housing LLC
N
ame
Telephone Fax Number
2918 Martinsville Road Suite A
2918 Martinsville Road Suite A
Current Mailing Address
Current Street Address
Greensboro NC 27408
Greensboro NC 27408
City State Zip
City State Zip
10, Deed Book No. 2802 Page Nu.2016
Provide a copy of the most Current deed.
Part B.
1. Person(s) or tinn(s) who are financially responsible for the land -disturbing activity (Provide a comprehensive list of all
responsible parties on an attached sheet):
Evolve Companies
[e-mail]
Name
E-mail Address
2012 Eastwood Road
2012 Eastwood Road
Current Mailing Address
Current Street Address
Wilmington 28403 28403
Wilmington NC 28403
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 AgenC
Name E-mail Address
Current Mailing Address Current Street Address -
City State Zip City State Zip
Telephone Fax Number
fib} 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
Cumenl Ma:ing Address
E-maii 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 forth
must be signed by the Financially Responsible Person if an individual or his attomeyin-fact, or if not an Individual, by an officer,
director, partner, or registered agent with the authority to execute instruments far the Financially Responsible Person), I agree to
provide corrected information should there by any change in the irtforma6on provided herein -
Type or print name
Signature
TWe or Authority - -
'Date
t, .a�1 r� a Notary Public of the County of
State of North Carolina, hereby certify that _[.>l `C
and being duly swam acknowledged that the above form wag xecuted by hire, appeared personally before me this day
f,
Witness my hand and notarial seal, this J t day of &N(kW Zp L- —
Sea! �Jjtj Ito Notary [[�� !_
`mot>> �V S 5u_,� i��, My commission exprres �,
2�rL��T,q�, ��=❑L
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