NCC232275_FRO Submitted_20230731

DocuSign Envelope ID:39BE80E4-F578-4788-B698-CIF45B977FA9
FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
EROSION & SEDIMENTATION CONTROL
1 R E LJ L L No person may initiate any land-disturbing activity on one or more acres, ' 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 Larkin Front 9
2. Location of land-disturbing activity: County Iredell City or Township Statesville
Highway/Street Amity Hill Latitude 35.754409 Longitude -80.882083
3. Approximate date land-disturbing activity will commence: 4/15/2022
4. Purpose of development(residential,commercial, industrial, institutional,etc.): Residential
5. Total acreage disturbed or uncovered(including off-site borrow and waste areas): 93 acres
6. Amount of fee enclosed:$ 16,275 . 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 X
8. Person to contact should erosion and sediment control issues arise during land-disturbing activity:
Name Denise Nicohols Rush E-mail Address [e-mail]
Telephone Cell# 704-968-3576 Fax#
9. Landowner(s)of Record(attach accompanied page to list additional owners):
Larkin Golf Course Development, LLC
Name Telephone Fax Number
2627 Brekonridge Centre Dr Suite 103
Current Mailing Address Current Street Address
Monroe NC 28110
City State Zip City State Zip
10. Deed Book No. 2448 Page No. 2048-2051 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):
True Homes. Inc [e-mail]
Name E-mail Address
2627 Brekonridge Centre Dr, Suite 103 2649 Brekonridge Centre Dr.
Current Mailing Address Current Street Address
Monroe NC, 28110 Monroe, NC 28110
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:
True Homes, LLC [e-mail]
Name of Registered Agent E-mail Address
2649 Brekonridge Centre Dr 2649 Brekonridge Centre Dr
Current Mailing Address Current Street Address
Monroe, NC 28110 Monroe, NC 28110
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.
Andrew J. McDonald Market Partner - Land Development
T ' name Title or Authority
/ Z IZ0ZZ
Si a e Date
I, Ncokteito Vdd1lAW LAW , a Notary Public of the County of CI c' r 4Q- v C
State of North Carolina, hereby certify that A i';'t V clA) M('i fii r-( 6( 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 day of 4 t& , 20 "2-L
J JO HIyS0. /tal.LP61 {/
Notary
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a County = My commission expires 1I I4 202(�
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9. Landowner(s)of Record(attach accompanied page to list additional owners): jeLAA161A, ,
Larkin Golf Course Development, LLC `-882B83F80744485.
Name Telephone Fax Number
2627 Brekonridge Centre Drive
Current Mailing Address Current Street Address
Monroe NC 28210
City State Zip City State Zip
10. Deed Book No. 2448 Page No.2048 Provide a copy of the most current deed.
2569 1764 8/5/2022
9. Landowner(s)of Record(attach accompanied page to list additional owners):
HPT Investment Holdings, LLC
Name Telephone Fax Number
455 Second St, 4th Floor
Current Mailing Address Current Street Address
Charlottesville VA 22902
City State Zip City State Zip
10. Deed Book No. 2900 Page No. 1477 Provide a copy of the most current deed.
, -DocuSigned by:
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8/5/2022