NCC222790_FRO Submitted_20220805

FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
SEDIMENTATION POLLUTION CONTROL ACT
No person may initiate any land -disturbing activity on one or more acres as covered by the Act before this
form and an acceptable erosion and sedimentation control plan have been completed and approved by
the Land Quality Section, N.C. Department of Environmental Quality. Submit the completed form to the
appropriate Regional Office. (Please type or print and, if the question is not applicable or the e-mail and/
or fax information unavailable, place NIA in the blank.)
Part A. Bur Oaks
1. Project Name
2. Location of land -disturbing activity: County Carteret City or Township Newport
Highway/Street Bur Oaks Blvd. Latitude34.788 Longitude-76.953
3
Approximate date land -disturbing activity will commence: 5/1 /2022
4. Purpose of development (residential, commercial, industrial, institutional, etc.): Residential
5. Total acreage disturbed or uncovered (including off -site borrow and waste areas): 12.72
6. Amount of fee enclosed: $ 1,600.00 . The application fee of $100.00 per acre
(rounded up to the next acre) is assessed without a ceiling amount (Example: 8.10 ac = $900.00).
7. Has an erosion and sediment control plan been filed? Yes No X Enclosed X
$. Person to contact should erosion and sediment control issues arise during land -disturbing activity:
Name Donald Aiken E-mail Address [e-mail]
Telephone cell # 910-508-0017
Fax #
9. Landowner(s) of Record (attach accompanied page to list additional owners):
Larry Wayne Styron
Name
Telephone Fax Number
PO Box 1834
Current Mailing Address
Current Street Address
Morehead City NC 28557
City State Zip
City State Zip
10. Deed Book No. 913 Page No. 399 Provide a copy of the most current deed.
Part B.
1. Company(les) or firm(s) who are financially
responsible for the land -disturbing activity (Provide a
comprehensive list of all responsible parties on an attached sheet.) If the company or firm is a sole proprietorship,
the name of the owner or manager may be listed as the financially responsible party-
D.R. Horton, Inc.
[e-mail]
_
Name
E-mail Address
131 Racine Dr., Suite 201
131 Racine Dr., Suite 201
Current Mailing Address
Current Street Address
Wilmington NC 28403
Wilmington NC 28403.
City State Zip
City State Zip
910-515-9561
Telephone
Fax Number

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 State Zip
Telephone Fax Number
(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:
Elizabeth Shelton [e-mail]
Name of Registered Agent E-mail Address
131 Racine Dr., Suite 201 131 Racine Dr., Suite 201
Current Mailing Address Current Street Address
Wilmington NC 28403 Wilmington NC 28403
City State Zip City State Zip
Telephone [phone] Fax Number
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 be any change in the information provided herein.
Donald Aiken
Type or rint na_
Siatlature
Assistant Secretary
Title or Authority
D e
I. _j � +� , a Notary Public of the County of
State of North Carolina, hereby certify that Ubn.).4 d__A-1 6�.g� T appeared
personally before me this day and being duly sworn acknowledged that the above form was
executed by him.
Witn 5XV 116111111 �notarial seal, this -1� day of , 20 _
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