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HomeMy WebLinkAboutNCC231873_FRO Submitted_20230615 WAKE COUNTY FINANCIAL RESPONSIBILITY/OWNERSHIP FORM SEDIMENTATION POLLUTION CONTROL ACT . T No person may initiate any land-disturbing activity on one or more acres as covered by the Wake County Unified Developplament d be e o sedimentation control n haveOr beeninance completedefor and this approvedform byand Wan ake Countyacceptabl Departmentersion ofand COUNTY NORTH CAROLINA Environmental Services, Water Quality Division. (Please type or print and, if the question is not applicable, place N/A in the blank.) Part A. 1. Project Name Hills at Rockbridge 2. Location of land-disturbing activity: Jurisdiction Wake County (Wake Co. or Municipality) Highway/Street Grasshopper Rd Latitude 35.739134 Longitude -78.459180 3. Approximate date land-disturbing activity will commence: June 2021 4. Type of development(residential, commercial, industrial, institutional, etc.): Residential 5. Total acreage disturbed or uncovered (including off-site utilities and borrow/waste areas): 4.8 6. Person to contact should erosion and sediment control issues arise during land-disturbing activity: Bobby Hilgoe Name E-mail Address bhilgoe@truehomesusa.com Telephone 919-669-4057 Cell# -. Fax# 7, Landowner(s)of Record (attach accompanied page to list additional owners): STAFFORD LAND COMPANY INC (919)422-3990 staffland1@earthlink.net Name(s) Telephone Fax or E-mail address 246 VALLEYFIELD LN Current Mailing Address Current Street Address SOUTHERN PINES NC 28387 City State Zip City State Zip 8. Deed Book No. 018464 Page No. 00001 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. Include requested information): Bobby Hilgoe bhiigoe@truehomesusa.com Name E-mail Address 900 Perimeter Park Dr, Suite E (}C6 1 Current Mailing Address Current Street Address Morrisville, NC 27560 1�, N L760 I City State Zip City State Zip Telephone 919-669-4057 Fax Number 2. (a) If the Financially Responsible Party is not a resident of Wake County, identify a designated agent in Wake County to receive any notice, process, pleading in any action or legal proceeding arising out of any matter relating to the Wake County Erosion and Sedimentation Control Ordinance and/or Land Disturbance Permit: 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: 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 be any change in the information provided herein. Typeprint name Title or Authority or °11/(j( ) I z.02- Signat Date I, i ck-VN:eA (ct> , a Notary Public of the County of JO L a State of North Carolina, hereby certify that +gyp 'C R� yip yJ, l- L' oe appeared personally before me this day and being duly sworn acknowledged that the above form was ecuted by him. Witness my hand and notarial seal, this o� day of l��o , 20 Daniel Gray Notary Seal C311( Notary Public My commission expires t Johnston County, NC