NCC222565_FRO Submitted_20220725

Town of H raters it e
Soil Erosion & Sedimentation Control Ordinance
3: %WA Financial Responsibility/ownership Form
No person shelf initiate any land -disturbing activity as defined in the Town of H ntersvifle Soli
Erosion and Sedimentation Control Ordinance pdur to cnmplefing and filing this form with tt Teen
of Huntersville. The financially responsible party will be on mcord as ft party to receive any
Notices of Violation or related documents relater to non-compharice issues Mfg the above
Ord -Inance, By firing 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
rest be assigned.
Please Type or Print
PART
1. Project where land -disturbing activity is to be undertaken: Ranson Read
Address of land -disturbing activity: 15013 Ranson load, Hunt r ville, NC 28078
. Approximate date land -disturbing activity will commence. August 1 2M
pant lay gar
4. Purpose of development (issidential; Commercial, Industrial, etc.); Residential
ident€al
. Approximate acreage of land to be disturbed or uncovered: I acres
6. Taal site acreage: 1. ae
7. Landowners of record (use blank pages to fist additional owners as necessary)
toner#I fame. Chris S Ferrell
Address: 15013 Kansan fed H nter ville, NC 28078
Telephone:
Email Address:
Owner #2 Nana. Susan C^Kinzier
Fax:
Address: 15215 Timberview Lane HuntersVille, NC 28078
Telephone;
Email Address:
Fax:
. Indicate Book and Page where the deed or instrument is filed (arse blank pages to list
additional deeds or instruments as necessary)
Book Page
Boo page
ii1
Beefy Page
Bel€ Page

Financial Responsibility/Ownership Fora - Continued
PART B
Person(s) orfirm(s) f nancially responsible for this lard -disturbing aeti�:
Persons or Firm, Maft my Homes
Address.. 2127 AyrsleY TOwn Blvd, Suite 201, Charlotte, NC 28273
T t pben70 7- 5 7 Fax:
Email Address_ [e-mail]
. North Carolina agent for the person or firm who is financially responsible;
eTson or Firm: Mattamy Homan
Address. 2127.AyrsleyTown Blvd, S ulte 201, ChaHotta, N C 282 7
_
Telephone: [phone] Fax:
Email Address. [e-mail]
. The above information is true and correct to the best of my knowledge and belief and way
provided ed by me whIla under oath. (Thisfirm must e sired by the financially responsible
person is an individual or by are officer, director, partner. attorney -in -fact, or other person
th authority to execs instruments for the financiaily responsible company or entity, if not
an individual)
PrinWedN:;I�me Titie
date
a rotary
Publicof the t of '� State of 4 hereby
Certify that ` — personally appeared
before me on this day and under eat
Witness y han � no -a] al, this
Notary Sjgnature.
My rr missi n Expires:
t this form was executed by him1her,
day of 'ram. ,
PO Box 664 f }
105 G [lead Pd., Ste 300t