NCC223660_FRO Submitted_20221026

FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
EROSION & SEDIMENTATION CONTROL
No person may initiate any land -disturbing activity on one or more acres, 'Y 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 Rocky River Storage
2. Location of land -disturbing activity: County Iredell CityorTownship Mooresville
Highway/Street Shearers Rd Latitude 35.534019 Longitude-80.798451
3. Approximate date land -disturbing activity will commence: January 4, 2022
4. Purpose of development (residential, commercial, industrial, institutional, etc.): commercial
5. Total acreage disturbed or uncovered (including off -site borrow and waste areas): 3.314
6. Amount of fee enclosed: $ 700.00 . An application fee of $175.00 per acre (rounded up to the next acre) is
assessed without a ceiling amount (Example: a 9-acre application fee is $1575). For projects > 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 Enclosed
8. Person to contact should erosion and sediment control issues arise during land -disturbing activity:
Name Ken Whitley E-mail Address [e-mail]
Telephone [phone] Cell # 336-469-2928 Fax #
9. Landowner(s) of Record (attach accompanied page to list additional owners):
RR3, L.L.C. 704-361-0936
Name Telephone Fax Number
2049 W Pine St
Current Mailing Address Current Street Address
Mount Airy NC 27030
City State Zip City State Zip
10. Deed Book No. 2637 Page No. 2459 Provide a copy of the most current deed.
Part B.
1. Person(s) or firm(s) who are financially responsible for the land -disturbing activity (Provide a comprehensive list of all
responsible parties on an attached sheet):
RR3, L.L.C. [e-mail]
Name E-mail Address
2049 W Pine St
Current Mailing Address Current Street Address
Mount Airy NC 27030
City State Zip City State Zip
Telephone [phone] Fax Number
Page 1 of 2

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:
Gary Ernst
Name of Registered Agent E-mail Address
21601 Scottcrest Circle
Current Mailing Address Current Street Address
Cornelius NC
City State
Telephone [phone]
28031
Zip City
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 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 by any change in the information provided herein.
Joe A. Dobbin Managing Member
Type or print name Title or Authority
November 29, 2021
Signature Date
------------------------------------------------------------------------------------------------------------------------------------
I, Stephen M. Sharpe , a Notary Public of the County of I redell
State of North Carolina, hereby certify that Joe A. Dobbin appeared personally before me this day
and being duly sworn acknowledged that the above form was executed by him.
Witness my hand and notarial seal, this 29th day of November 20 2021
Stephen M. Sharpe Notary
NOTARY PUBLIC
Iredell County, NC
My Commission Expires 01-25-25
My commission expires 01-25-2025
Page 2 of 2