NCC230726_FRO Submitted_20230320

Town of Cary
Stormwater Division
316 N. Academy St.
Cary, NC 27513
FINANCIAL RESPONSIBILITY - OWNERSHIP FORM
No person may initiate any land -disturbing activity covered by the Town of Cary Sedimentation and
Erosion Control Ordinance before completing and filing this form with the Town of Cary Stormwater
Division. Indicate N/A if a question is not applicable.
PROJECT NAME Courtyards at Lochmere
PROJECT DEVELOPMENT PLAN # 22-DP-0167
PROJECT LOCATION 4908, 5000, 5100 Lilly Atkins Road & 0, 7540 Holly Springs Road
APPROXIMATE DATE OF PROJECT INITIATION January 2023
ACREAGE OF LAND TO BE DISTURBED 23.4 Acres
PERSON(S) OR FIRM(S) FINANCIALLY RESPONSIBLE FOR THIS LAND -DISTURBING ACTIVITY:
(If out of state, a registered agent in North Carolina must be used.)
EC New Vision Carolinas, LLC
Name (Person or Firm)
500 Stonehenge Parkway
Street Address (No PO Box)
Dublin, OH 43017
City State Zip
614-761-1010
Telephone Number
N/A
Fax Number
[e-mail]
E-Mail Address
REGISTERED AGENT FOR THE PERSON OR FIRM WHO IS FINANCIALLY RESPONSIBLE:
Corporation Service Company
Name
2626 Glenwood Avenue, Suite 550
Street Address (No PO Box)
Raleigh, NC 27608
City State Zip
Town of Cary
316 North Academy Street, Cary, NC 27513 PO Box 8005, Cary, NC 27512-8005
Tel [phone] www.townofcar,} org
Form updated 0211712022

Telephone Number
Fax Number
Ahc,� _uyL��' cow
E-Mail Address
The Town reserves the right to contact either the financially responsible person or registered agent listed
below in case of violation. Please indicate your preference below.
Mark Stiglitz
Financially Responsible Person
OR Nicole Loeffler
Registered Agent -
THE ABOVE INFORMATION is true and correct to the best of my knowledge and belief and as provided
by me while under oath. (This form must be signed by the financially responsible person if an individual or
by an officer, director, partner, attorney -in -fact, or other person with authority to execute instruments for
the financially responsible person if not an individual.)
Mark Stiglitz
Type or Print Name
Signature
Title orA hority
It
Date
North Carolina
4 " County
I, So ntVi L �l iTi✓1 , a Notary Public of the County of North
Carolina, do hereby certify that 01 R r It, -1'o _ personally appeared before me this day
and under oath acknowledged that the above form was executed by him/her. Witness my hand and
notarial seal, this 11 day of 3AY1u4'A
J
Nota ublic My mission(e ires 1.e6eyviicay'k I 2q
23
Sarah J Linton
NOTARY PUBLIC vim.
Wake County
North Carolina
Nly Commission Expires December 8, 2024
Town gtQg y
316 North Academy Street, Cary, NC 27513 PO Box 8005, Cary, NC 27512-8005
Tel [phone] www.townotoarv.ora
Form updated 0211712022
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