HomeMy WebLinkAboutNCC230291_FRO Submitted_20230201. ^Z
--� Soil Erosion. and Sedimentation. Control
Financial Responsibility/Ownership Form
NOT REQUIRED TO BE COMPLETED FOR RESIDENTIAL LOT PERMITS-:
PLEASE READ THE. FOLLOWING INFORMATION:
1) This -section must be -signed -in the presence of Notary
2). All .Land -Disturbing permits are valid for up to (2) yearn from the date. of issuance. If circumstances warrant, the:.p.erinit may be.
extended .far (2) years per the conditions. of. the Chathaan County. Soil Erosion and. Sedimentation Control .Ordinance. Upon written
notice, the Land -Disturbing permit may be revoked for failure to comply with the Ordinance. If the permit is revoked', all other
permits and approvals arewithheld until the property is once .again in compliance with Chatham County regulations. Also, upon
written notice, a civil penalty (fine).can be.instigated against the. property. owner and/or additional financially responsible party (if any)
for violations of the Chatham County Soil. Erosion and Sedimentation Control Ordinance. This penalty is up to. S5000.00 per violation
per day and is assessed daily for every. day the property is in violation. Interfering: with or hampering an inspection can result in a civil
penalty without written notice.
3) The information provided on.this form is true and correct to.the..best of my knowledge and belief and was .provided by Ine while
under oath.
4) 'Phis form niust be signed.by the property owner if.an individual. If owned. by a company or corporation, this: form.must be signed
by an officer,. director, .partner, attorney -in -fact,. or other person with authority to execute instruments .for the corporation and
accompanied by a complete list of all partners, managing members .and registered agents of the company or corporation.
OWNER OF PROPERTY:
Name and Title: Catherine Ruster and. Brian Ruster
Company (if a plicable):
Signature:
ADDITIONAL FINANCIALLY RESPONSIBLE PARTY (if any):.
Name andTitle:
Company:
Signature-,
NORTH. CAROLINA AGENT (if any):
Name and Title: Timothy Schreiber
Company: Schreiber Construction, LLC
5 ignature:
I; -�. ' t .tom a Notary Publico'F Couniy in the state
of do hereby certify tha °4- e'personally
appeared before me this day and under oath acknowledged reading the information. above and .acknowledged that the.
above forth was. executed by'hiiti or her: I
Witness rriy hand and officialseal, this the 7 day of , n_�
atary.l'.ublic J-_A �- � '
rT _eTtz1e tT
My commission expires—kCM._. R96 �U227-_) (SEAL).
tier ru�r LINt]A S. BIRn NE�t
•'g; . Notary Public - 5iake ❑f glarida
t ;, Z Commission rk.GG 929987
?aF �` ': My Camta. Expires Occ a8. 2023 page 3 Of 3
Soil Erosion and Sedimentation Control
C Q 9V ft t 91 f. It " I I NTi'Y Financial Responsibility/Ownership Form
N �1 - 1 �1 ( A N [l l I W A
NOT REQUIRED TO BE COMPLETED FOR RESIDENTL4L LOT PERMITS.
PLEASE READ THE FOLLOWING INFORMATION:
1) This section must be signed in the presence of a Notary
2) All Land -Disturbing permits are valid for up to (2) years from the date of issuance. If circumstances warrant, the permit may be
extended for (2) years per the conditions of the Chatham County_ Soil Erosion and Sedimentation Control Ordinance. Upon written
notice, the Land -Disturbing permit may be revoked for failure to comply with the Ordinance. If the permit is revoked, all other
permits and approvals are withheld until the property is once again in compliance with Chatham County regulations. Also, upon
written notice, a civil penalty (fine) can be instigated against the property owner and/or additional financially responsible party (if any)
for violations of the Chatham County Soil Erosion and Sedimentation Control Ordinance. This penalty is up to $5000.00 per violation
per day and is assessed daily for every day the property is in violation. Interfering with or hampering an inspection can result in a civil
penalty without written notice.
3) The information provided on this form is true and correct to the best of my knowledge and belief and was provided by me while
under oath.
4) This form must be signed by the property owner if an individual. If owned by a company or corporation, this form must be signed
by an officer, director, partner, attorney -in -fact, or other person with authority to execute instruments for the corporation and
accompanied by a complete list of all partners, managing members and registered agents of the company or corporation.
OWNER OF PROPERTY:
Name and Title: Catherine Buster and Brian Ruster
Company (if applicable):
Signature:
ADDITIONAL FINANCIALLY RESPONSIBLE PARTY (if any):
Name and Title:
Company:
Signature:
NORTH CAROLINA AGENT (if any):
Name and Title: Timothy Schreiber
Company: Schreiber Construction, LLC
Signature:
1, �Scxw eegc '5Enx, -4.,rCi , allotary Public of QAIW kc— County in the state
of do hereby certify that Tlmcz2r+-. Sc+44tc-t 9&n-- personally
appeared before me this day and under oath acknowledged reading the information above and acknowledged thatthe
above form was executed by him or her.
Witness my hand and official seal, this the ti4 day of 20-L-L. �iulrri
SIC
� oT�
Notary Public 9y 0
My commission expiresc7:1(orl I-WW (SEAL) +em u+o V
Page 3 of 3