NCC221779_FRO Submitted_20220512

Town of Huntersville
cl*mr64le Soil Erosion &Sedimentation Control Ordinance
NORTH CAROLINA Financial Responsibility/Ownership Form
No person shall initiate any land -disturbing activity as defined in the Town of Huntersville Soil
Erosion and Sedimentation Control Ordinance prior to completing and filing this form with the Town
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 filing this form, the parties are not relieved from any other permits that may be
required for the Project. If the financially responsible party is out of State, a North Carolina agent
must be assigned.
Please Type or Print
PART A
1. Project where land -disturbing activity is to be undertaken: Vermillion Front
2. Address of land -disturbing activity: 438 Huntersville-Concord Rd.
3. Approximate date land -disturbing activity will commence: March 01 2021
Month Day Year
4. Purpose of development (Residential, Commercial, Industrial, etc.): Residential
5. Approximate acreage of land to be disturbed or uncovered: 13.01 AC
6. Total site acreage: 14.04 AC
7. Landowners of record (use blank pages to list additional owners as necessary)
Owner #1 Name: Bowman Development Group
Address: 13815 Cinnabar Place,
Huntersville, NC 28078
Telephone: [phone] Fax:
Email Address: bowman3l @gmail.com
Owner #2 Name:
Address:
Telephone: _
Email Address:
Fax:
8. Indicate Book and Page where the deed or instrument is filed (use blank pages to list
additional deeds or instruments as necessary)
Book 22699 Page 750 Book 08894 Page 472
Book 22403 Page 715 Book 20587 Page 572
20623 404

Financial Responsibility/Ownership Form - Continued
PART B
1. Person(s) or firm(s) financially responsible for this land -disturbing activity:
Persons or Firm: Bowman Development Group
Address:
Telephone:
13815 Cinnabar Place
Huntersville, NC 28078
[phone]
Email Address: bowman3l @gmail.com
Fax:
2. North Carolina agent for the person or firm who is financially responsible:
Person or Firm:
Address:
Telephone:
Email Address:
Fax:
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 individual or by an officer, director, partner, attorney -in -fact, or other person
with authority to execute instruments for the financially responsible company or entity, if not
an individual)
PIOUIUT 131 QN Anl Norplrwr
Printed Name Title
!u
Io•13•Zo
Date
a Notary
Public of the County of GUST &EJ —,State of tltmm CAaDUMA , hereby
certify that Vh aee-F 0U%&A04 personally appeared
before me on this day and under oath acknowledged that this form was executed by him/her.
Witness my hand and notarial seal, this % S day of cracic2 20 2-0
Notary Signature:--'
My Commission Expires: 23 2iD 2H
\``\\\\\��PS� PI SIM'/ 1/1,
\.�I `i1,
Notary Public —
Gaston County
,iR`������
Town of Huntersville
PO Box 664
105 Gilead Rd., Ste 300
Huntersville, NC 28070