NCC223330_FRO Submitted_20220926

Town of Huntersville
T kw'" of 0
�i Soil Erosion & Sedimentation Control Ordinance
NORTH r `ROT TNA 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: Huntersville
2. Address of land -disturbing activity: 10320 Hagers Road Huntersville, NC 28078
3. Approximate date land -disturbing activity will commence: 12 01 2022
Month Day Year
4. Purpose of development (Residential, Commercial, Industrial, etc.): Residential
5. Approximate acreage of land to be disturbed or uncovered: 53.00
6. Total site acreage: 61.73
7. Landowners of record (use blank pages to list additional owners as necessary)
Owner #1 Name: Judy Ann Hager Collins
Address: Mailing Address: 6364 Dane Ave. Cocoa, FL 32927
Telephone: [phone]
Fax:
Email Address: [e-mail]
Owner #2 Name: Robert Brice Lowrance & Mason A. Lowrance Jr.
Address: Mailing Address: 19018 Mountainview Dr. Cornelius, NC 28031
Telephone: [phone]
Email Address: [e-mail]
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 19252 Page 822 Book 03385 Page 485
Book 29539 Page 135 Book 3784 Page 428

7. Landowners of record (use blank pages to list additional owners as necessary) :
Owner #1 Name: Robert Brice Lowrance
Address: Mailing --Address. 19018 Mountainview Dr. Cornelius. NC 28031
Telephone:
704.575.4520
Fax:
Email Address: [e-mail]
Owner #2 Name: Fort Mevers Real Estate Grour) LLC
Address: Mailing Address: 5229 N Hiatus Rd. Sunrise, FL 33351
Telephone:
Email Address:
Fax:

Financial Responsibility/Ownership Form - Continued
PART B
Person(s) or firm(s) financially responsible for this land -disturbing activity:
Persons or Firm: M/I Homes of Charlotte, LLC
Address: 5530 77 Center Drive Suite 100
Charlotte, NC 28217
Telephone: [phone] Fax:
Email Address: [e-mail]
2. North Carolina agent for the person or firm who is financially responsible:
Person or Firm: M/I Homes of Charlotte, LLC
Address: 5530 77 Center Drive
Charlotte, NC 28217
Telephone: [phone]
Email Address: [e-mail]
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)
Cody Simoneaux
Prin me
Signat re
VP of Land Development
Title
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Dat
i,L�Q 0w I��l�f\t�1�'�1 a Notary
Public of the County of MeL 1u\1 WCA State of N0(filn C(Aro h A hereby
certify that CC O Cal n 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 __ day of �,I�VI l�j Y" , 201�_.
Notary Signature:}
My Commission Expires:
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Town of Huntersville
PO Box 664 = JANUARY 16, z
C 2025
105 Gilead Rd., Ste 300 = % e
Huntersville, NC 28070 '.,'� ' •� URG �;•' ti
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