NCC232282_FRO Submitted_20230731

• PLAN REVIEW/FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
CATAWBA COUNTY CODE OF ORDINANCES, CHAPTER 16 ARTICLE V
SOIL EROSION AND SEDIMENTATION CONTROL
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 Catawba County
Utilities and Enginecting Department. (Please (1pe nr print, and If question is not applicable,please N/A in the blank)
PART A
I. Job Name I2ND SWEET TOWNHOMES
2. PIN or Q1 I Address (378111567598
3. Purpose of development (residential, commercial, industrial, institutional,etc.)IRESIDENTIAL
Approximate soil disturbance date 16/20/23
S. Total acreage disturbed or uncovered (including off-site borrow and waste areas) 13.94
6. Has an erosion and sedimentation control been filed? r Yes r No R Attached
7. If you have an Erosion Control billing account, would you like this to be billed? r Yes R No
Account Number (NA
PEOPLE
S. Person to contact should erosion and sediment control issues arise during land-disturbing activity
Name 1—rist,26,11 fL E-mail address I /n 0 S a 9n'la1•e
Telephone I Cell # I f 2'- V -' 717s Fax# I
9. Landowner(s) of Record (attach accompanied page to list additional owners)
Name IVR FARMS LLC Telephone I Fax#
Current Mailing Address (7271 LONG ISLAND ROAD
City (CATAWBA State INC Zip 128609
Current Street Address ISAME
City I State I Zip
10. Deed Book No. (3795 Page No. fri38
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 attached sheet):
Name IVR FARMS,LLC E-mail address [e-mail]
Current Mailing Address (7271 Long Island Rd.
City (Catawba State INC Zip 128609

I.
1 tint nt �Iti�i 1 1,I,I'cc& ( ' 1 1 I.nt 10,,,„,1 AA
t +t. i Atlwl.l. `bite 'IC Zip J286O9
t i,-Llt,•t1c I'm tl(. ;u4 --- Fax ll I
t r 1 II the tinsn..ull rrvionaihle patty is MA a resident of North Carolina, give name and street address of the
t1c‘tpnn1iN1 \,.nh CanAma Agent.
lame INa Ii-mail address I
t, u^vnt \lattmc .'1tidrr%%
t, CA - State I Zip I -
.'i1..17711 Strcrt .\duress I
`17. State I Zip I
cie hone Fax#
t'1 if the financially responsible party is a Partnership or other person engaging in business under assumed name,
attadi a coPs of the Certificate of Assumed Name. If the financially responsible party is a Corporation, give name
any smrct address of the Registered Agent:
\ame f E-mail address I
Current Mailing Address I -
Cit) I State I
-- — Zip I
Current Street Address I — —
City 1 State I- Zip I
Telephone I Fax # I
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 informatio should there be any change in the information provided herein.
V . TEA- . /9.,,V, "- �e,,,,, .—
Type ri e Title of Aut on
� G/1 Z-3
Si tur Date
I, T,..4 0_. L:-+Ie ,a Notary Public of the County of (I a LA 14 State of North
Carolina,hereby certify that Y. by s'Li/ T,c appeared personally before me this day and being duly
sworn acknowledge that the above form was executed by him.
oa
Witness my hand and no Atils „?. day of 3 ,.,..C ,2031.
Seal -`,.c,a^"".Fto T(F '2= C, o .
. M- = Notary
0 SLic ; - My Commission expires 0 9/5/42 o 27
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