NCC241211_FRO Submitted (2)_20240419

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Submit to the Water Resources Department, 316 N. Academy St., Cary, NC 27513
Town of Cary
'e '` Water Resources Department
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 GREEN LEVEL TRAIL(EARLY GRADING PERMIT)
PROJECT LOCATION 4216 GREEN LEVEL WEST ROAD
APPROXIMATE DATE OF PROJECT INITIATION 5/1/2023
ACREAGE OF LAND TO BE DISTURBED 50.26
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.)
Erica Leatham do M/I Homes of Raleigh,LLC
Name(Person or Firm)
1511 Sunday Drive, Ste 100
Street Address(No PO Box)
Raleigh, NC 27607
City State Zip
[phone]
Telephone Number
[phone]
Fax Number
[e-mail]
E-Mail Address
REGISTERED AGENT FOR THE PERSON OR FIRM WHO IS FINANCIALLY RESPONSIBLE:
Corporation Service Company •
Name
2626 Glenwood Ave, Ste 550
Street Address(No PO Box)
Raleigh, NC 27608
City State Zip
[phone]
Telephone Number
[phone]
Fax Number
[e-mail]
E-Mail Address
TOWN of CARY
316 North Academy Street•Cary,NC 27513•PO Box 8005•Cary,NC 27512-8005
tel [phone]•fax [phone]•www.townofcary.org

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.
Erica Leatham OR
Financially Responsible Person 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.
Erica Leatham
T e or Prin e
X
ature
VP Land for M/I Homes of Raleigh, LLC
Title or Authority
4/18/2023
Date
North Carolina
Wake County
Kira Parker , a Notary Public for Wake County, North Carolina, do
hereby certify that Erica Leatham personally came before me this day and acknowledged
she VP Land Mil Homes of Raleigh, LLC
that he is of , and acknowledged, on behalf of
M/I Homes of Raleigh, LLC the due execution of the foregoing instrument.
Witness my hand and official seal, this the 18th day of April 20 23
Vt
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• _
Notary Public - •
. ALIBLtC
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My commission expires May 8 , 20 27 y,•�
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TOWN of CARY
316 North Academy Street •Cary,NC 27513•PO Box 8005• Cary,NC 27512-8005
tel [phone]•fax [phone]•www.townofcary.org
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