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HomeMy WebLinkAboutNCC220713_FRO Submitted_20220210CITY OF MONROE STANDARD SPECIFICATIONS AND DETAIL MANUAL 07.06 EROSION CONTROL FORMS AND CHECKLISTS 07.06.01 EROSION CONTROL FINANCIAL RESPONSIBILITY FORM No person may initiate any land -disturbing activity as defined in Chapter 158 of the Monroe City Code prior to completion of this form, and an applicable and acceptable erosion and sedimentation control plan has been approved by the City of Monroe Engineering Department. (Please type or print) Part I 1. Name of Project Scotch Meadows 2. Address where land disturbing activity will take place 2206 Olive Branch Road (Lots 1-26, 139-162) 3. Approximate date disturbing activity will commence 12 _/ 01 / 2021 4. Purpose of development (residential, commercial, industrial, etc.) Residential 5. Total acreage of land to be disturbed or uncovered 6.54 AC 6. Amount of fee enclosed (fee will be the amount of current policies per acre multiplied by the total number of acres or any part of an acre from number 5. i.e. 7.28 acres equals 8 acres.) $1,100.00 7. Agent to contact should sediment control issues arise during land disturbing activity Name Keith Fenn Phone 980-269-6609 8. Landowner(s) of Record (use blank page to list additional owners) Name True Homes, LLC Mailing Address 2649 Brekonridge Centre Dr Monroe, NC 28110 Street Address 2649 Brekonridge Centre Dr Monroe, NC 28110 Name Mailing Address Street Address 9. Indicate Book and Page where deed of the property where land disturbing activity will take place is recorded (use blank page to list additional owners) Book 7860 Book Pao,. 507 Pace 10. Tax Map Parcel Number where land disturbing activity will take place 09 -- 143 -- 032 07-18 Permits, Checklists, and Forms Division 07 CITY OF MONROE STANDARD SPECIFICATIONS AND DETAIL MANUAL Part II Person(s) or firm(s) who are financially responsible for this land disturbing activity (use blank page to list additional owners) Name True Homes, LLC Name Mailing Address_2649 Brekonridge Centre D Monroe, NC 28110 Street Address 2649 Brekonrdige Centre Dr. Monroe, NC 28110 Phone 980-269-6609 Fax Mailing Address Street Address_ Fax A) If the Financially Responsible Party is not a resident of North Carolina, give name and address of a North Carolina Agent Name of Registered Agent Mailing Ad Street address City State Zip Phone Email Fax 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 the name and street address of the Registered Agent: Name of Registered Agent Mailing Address Pli Street address City State Gip Email Fax The above information is true and correct to the best of my knowledge and belief and was provided by nee under oath. I agree to provide corrected information should there be any change in the information provided herein. (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) Type or Print Name e6eV 2�70,,? Sisnature�'���� Title_ O^ )`►� r— Date' �( E, �t f �1y �C�Y W� \,\ Oi�-i n Notary Public of the County of C V State of'North Carolina. liereby certify that appeared pe:•sonally bet'om me this day and being dily swore acknowledged that the above Conn was executed by hint. Witness my hand and notarial seal, this _�_ day of--WQI SEAL Mary MarmflHon NOTARY PUBLIC (Nolaryv I V )T Mecklenburg County North Carolina My commission expires My Comm. Expires April 12, 2©2s 1 07-19 Perinits, Checklists, and Fortes Division 07