NCC231364_FRO Submitted_20230508

8/30/2021 Rowan County
Financial Responsibility/Ownership Form Sedimentation Pollution Control Ordinance
No person may initiate any land-disturbing activity on one or more acres as covered by the ordinance before this form
and an acceptable erosion and sedimentation control plan have been completed and approved by the Rowan County
Environmental Management Department.
Part A Parcel ID Number
115-062, 117-165,
117-204
1.Project Name
Kensington Subdivision
2.Location of land-disturbing activity(Highway/Street)
N Main St (US 29), China Grove
Latitude Longitude
35.581061 -80.560535
3.Approximate date land-disturbing activity will be commenced
5/1/22
4.Purpose of development(residential,commercial,industrial,etc.)
Single Family Detached Residential
5.Approximate acreage of land to be disturbed or uncovered
54.5 acres
6.Person to contact should sediment control issues arise during land-disturbing Cell Phone Number
activity
704-288-7256
Andrew McDonald, Market Partner, Land Development
Email Address
[e-mail]
https://www.rowancountync.gov/FormCenter/Print?formI D=96&Preview=YES&Save=False&saved ProgressID= 1/3

8/30/2021 Rowan County
7.Landowner of Record Landowner of Record
Dependable Development, Inc
Name Name
Current Mailing Address Current Mailing Address
2649 Brekonridge Centre Dr
Monroe NC, 28110
8.Recorded in Deed Book Number Page Number
1333 289
Part B
1.Person or Firm who are financially responsible for this Person or Firm who are financially responsible for this
land-disturbing activity land-disturbing activity
True Homes, Inc
Name of Person(s)or Firm(s) Name of Person(s) or Firm(s)
Current Mailing Address Current Mailing Address
2627 Brekonridge Centre Dr, Suite 103
Monroe NC, 28110
Phone Number Phone Number
704-288-7256
a.If the Financially Responsible Party is not a resident of North Carolina,give name and street address of a North Carolina
Agent.
Name of Agent Name of Agent
/i
Current Mailing Address Current Mailing Address
Phone Number Phone Number
https://www.rowancountync.gov/FormCenter/Print?formlD=96&Preview=YES&Save=False&savedProgresstD= 2/3

8/30/2021 Rowan County
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 the name and street
address of the Registered Agent.
Name of Registered Agent
Current Mailing Address Current Street Address
Telephone Number Telephone 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 authority to execute instruments for the Financially Responsible Person).
I agree to provide correctional information should there be any change in the information provided herein.
Name Title or Authority
M D� y t--DOlq ift4 MI611?-1��-r Pf�1Z��1 — L414
Signature Date
mm/dd/yyyy
I, _4, eroicu-n,r t ,a Notary Public of the County of 0 State of North Carolina,
hereby certify that Aflk ie.:„.: ("14-4 z appeared personally before me this day and being duly sworn acknowledged
that the above form was executed by him/her.Witness my hand and seal of Notary,this '1 day of 14 'h ,2022.
Notary My commission expires
1
mm/dd/yyyy 724,1
E I8 of
Seal
Seal
140r
Checklist :C
Download a copy of the Erosion and Sedimentation
Control Plan Checklist(PDF) iO//i 4)
0; c�UN N.,"0
https://www.rowancou ntync.gov/FormCenter/Print?form I D=96&Preview=YES&Save=False&savedProgressl D= 3/3