NCC242623_MODIFICATION Supporting Doc (ADDL LOTS)_20260128 (2)

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 Engineering Department. (Please type or print, and if question is not applicable,pleaseN/A in the blank)
PART A
1. Job Name (The Hamptons at Hickory Lots 1-9,108-124,267-340
2. PIN or 911 Address 1371305177628
3. Purpose of development(residential, commercial, industrial, institutional,etc.)IResidential
4. Approximate soil disturbance date 'January 2026
5. Total acreage disturbed or uncovered(including off-site borrow and waste areas)113.85 acres
6. Has an erosion and sedimentation control been filed? J Yes r No J Attached
7. If you have an Erosion Control billing account,would you like this to be billed? r Yes r No
Account Number I
PEOPLE
8.Person to contact should erosion and sediment control issues arise during land-disturbing activity
Name 'Jake Flores E-mail address [e-mail]
Telephone [phone] Cell# IN'A Fax# IN/A
9. Landowner(s) of Record(attach accompanied page to list additional owners)
Name IHVY 1700 LLC Telephone [phone] Fax# IN/A
Current Mailing Address 1361 N.Center Street
City 'Hickory State INC Zip 128601
Current Street Address 11361 N.Center Street
City Hickory State INC Zip 128601
10. Deed Book No. 13741 Page No. 0482
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 ID.R.Horton,Inc. E-mail address lj05@dth0rt00m
Current Mailing Address 18025 Arrowridge Blvd
City Charlotte State INC Zip 128273

Current Street Address I8025 Arrowridge Blvd.
City (Charlotte State INC Zip 128273
Telephone I704-577-0308 Fax# IN/A
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 I
Current Mailing Address I
City State I Zip I
Current Street Address
City I State I Zip I
Telephone Fax# I
2. (b)If the financially responsible party is a Partnership or other person engaging in business under 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 ICT Corporation System E-mail address ([e-mail]
Current Mailing Address 1160 mine lake court,#200
City !Raleigh State INC Zip 127615
Current Street Address 160 mine lake court,#200
City !Raleigh State INC Zip 127615
Telephone I855-316-8944 Fax# IN/A
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.
P. Fiore's D iY , 54.60Ptivockr CortittranCt.,
Type or rin � Title of Authority
1/9/202A
Signatur Date
I, e 0-1 , a�Q t Public of the County of `' L 1-2r\Y> d- State of North
Carolina,hereby certify that J�'� . 0 appeared personally befori me this day and being duly
sworn ackno0er t bove form was executed by him.
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Witness z d n r seSk,this day of orua I ,mace
eat �� ���AR Y 1' z •
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Notary
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