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HomeMy WebLinkAboutNCC233296_FRO Submitted_20231128 FINANCIAL RESPONSIBILITY/OWNERSHIP FORM SEDIMENTATION POLLUTION CONTROL ACT No person may initiate any land-disturbing activity on one or more acres as covered by the Soil Erosion and Sedimentation Control Ordinance of the City of Greenville (Title 9, Chapter 8) before this form and an acceptable erosion and sedimentation control plan have been completed and approved by the City of Greenville, Engineering Division. (Please type or print and, if the question is not applicable or the e-mail and/or fax information unavailable, place N/A in the blank.) Part A. 1. Project Name THE ENCLAVE 2. Location of land-disturbing activity: County PITT City or Township GREENVILLE Highway/Street LT HARDEE ROAD _ Latitude 35.577528N Longitude 77.305717W 3. Approximate date land-disturbing activity will commence:SEPTEMBER 1,2023 4. Purpose of development(residential,commercial, industrial, institutional,etc.):RESIDENTIAL 5. Total acreage disturbed or uncovered(including off-site borrow and waste areas):30.61 ac 6. Amount of fee enclosed:$3,061.00 . The application fee of$100.00 per acre (rounded to the tenth of acre) is assessed without a ceiling amount (Example: a 9-acre application fee is $900). 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 LANDON WEAVER E-mail Address iweaverabillclarkhomes.com Telephone 814-1481 CeII# N/A Fax# N/A 9. Landowner(s)of Record (attach accompanied page to list additional owners): Bill Clark Homes of Greenville, LLC 355-5805 Name Telephone Fax Number 200 E.Arlington Blvd,Ste A Current Mailing Address Current Street Address Greenville, NC NC 27858 City State Zip City State Zip 10. Deed Book No.4353&4373 Page No.304&50 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): Bill Clark Homes of Greenville, LLC Name E-mail Address 200 E.Arlington Blvd,Ste A Current Mailing Address Current Street Address GREENVILLE NC 27858 City State Zip City State Zip Telephone 252-355-5805 Fax Number 1 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 NC 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: Name of Registered Agent E-mail Address Current Mailing Address Current Street Address City State Zip City State Zip Telephone 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 by any change in the information provided herein. Landon Weaver MANAGER Type or print nam Title or Authority r Maack IL c) u,&.- 71 .7/ 3 Sig ure Date R3 y , S frr'c>>,`3 , a Notary Public of the County of Jar )--t State of North Carolina, hereby certify that J, / can ur t).)1L 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,27 day of Jc..i,J , 20 '), ,O STROV 1•, .�� O.•• Noar `--SSeePRV t + .00 w My commission expires 212_) L 5` /"I,A'n-Co\