NCC233416_FRO Submitted_20231116

6/27/23 7:28 AM 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
130B-096
1.Project ?game"
Landis Aprartrnents
2.Location of land-disturbing acti%11% (Higli av 'trect)•
West Ryder Ave
Latitude Longitude
35.554 -80.61 7
3.Approximate date land-disturbing activity will be commenced
l 9/01/23
4.Purpose of development(residential,commercial,industrial,etc.)
Residential
5.Approximate acreage of land to be disturbed or uncovered*
3.8 AC
6. Person to contact should sediment control issues arise during land-disturbing Cell Phone Number*
activity*
704-785-5345
Spencer Ross
`this Information will be made available on the Rowan County Planning&Development webslte.
Email Address
[e-mail]
httpsJlwww.rowancountync.gov/FormCenter/Print?formlD=96&Preview=YES&Save=False&savedProgresslD= 1/3

6/27/23,7:28 AM Rowan County
7.Landowner of Record Landowner of Record
Dynamic Developers of the Carolinas
Name Name
Current Mailing Address Current Mailing Address
210 Oak Ave. Kanapolis, NC 28081
Recorded in Deed Book Number rage s umber
1381 880
Part B
I. Person or Firm who are financially responsible for this Person or Firm who are financially responsible for this land-
land-disturbing ith disturbing activity
Dynamic Developers of the Carolinas
Name of Person(s)or Firm(s) Name of Person(s)or Firms)
urrent Mailing Address Current Mailing lddress
210 Oak Ave. Kanapolis, NC 28081
Phone Number Phone Number
704-785-5345
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 lame of Agent
Current Mailing Address Current Mailing Address
Phone Number Phone Number
httpsJ/www,rowancountync.gov/FormCenter/Print?formlD=96&Preview=YES&Save=False&savedProgresslD= 2/3

6/27/23,7:28 AM Rowan County
h. 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
Spencer Ross
Current Mailing Address Current Street Address
210 Oak Ave Kanapolis, NC 28081
Telephone Number Telephone Number
704-785-5345
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
Spexc e r evs-S /t/tmbc_r/V a
ef
9
Signature Date
mm/dd/yyyy
�lZ �/23
1, SO Ann S. LAneLj ,a Notary Public of the County of CObarru State of North Carolina,
hereby certify that Spent e M' Ro SS appeared personally before me this day and being duly sworn acknowledged
that the above form was executed by himther.Witness my hand and seal of Notary,this 2,1 day of t0i11411 ,202.
Notary Nly commission expires
rmm/dd/yyyy C e I '21527
Selitak a:uu7.
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Seal `.%`,,PN ANA/ ''-- -,
Checklist _ CO; N. 0 Tq,Q I'-
Download a copy of the Erosion and Sedimentation : y ;
Control Plan Checklist(PDF) 4y8 L I G
"PAN.-
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https://www,rowancountync.gov/FormCenter/Print?formlD=96&Preview=YES8 Save=False&savedProgresslD= 3/3